Abstract Chapter 2

Chapter 2 examines the Italian NHS with regard to the institutional arrangements, the infrastructure endowment, the use of healthcare  resources and the overall patients' need satisfaction, and it aims to place the Italian NHS in the international context (EU, North America and BRIC countries). The analysis re-elaborates the most recent data published by the Ministry of Health and by Agenas (Piano Nazionale Esiti), further integrated with evidence on the determinants of health needs and utilization, based on studies carried out by ISTAT between 2016 and 2017. With respect to the institutional arrangements, after the recent rearrangement processes occurred at the regional level between 2015 and 2017, no change is observed over the last 12 months. As indicated in the previous edition of the Report, the number of health authorities (including the ASST) is equal to 120, while the number of local healthcare organizations remains stable to 43 units. As of 2016 (last available data), the infrastructure endowment exhibits a decrease in the number of hospital beds, although this trend is limited to inpatient care beds (-41.2% compared to 1997). Day hospital beds, on the other hand, have remained broadly stable during the same time span (-21 hospital beds), although from 2008 certain services and procedures are increasingly granted in outpatient settings. At the international level, we observe a decreasing number of hospital beds in the countries analyzed since 2005 and a strong heterogeneity in terms of distribution between acute and long-term care beds. Hospital admissions show a downward trend as well, with a significant decrease between 2011 and 2016 (-30%) that is aligned with the resource evolution, reaching a value below OECD average and an average length of stay aligned with the main European countries. Finally, need satisfaction can be analyzed through indirect measures only: traveling for care appears to be essentially stable; waiting times are longer for procedures and interventions that do not impact patient survival directly; the percentage of chronic patients in good health decreases with age and shows lower values in the southern part of the country. With regard to inappropriate hospitalization (asthma, COPD and diabetes), Italy has the lowest value among the analyzed countries, while it keeps one of the highest c-section rates, although exhibiting a downward trend in recent years.