Federsanità ANCI is the Italian association gathering public hospitals (AO), public teaching hospitals (AOU), public healthcare companies (ASL) and municipal departments dealing with social services. Federsanità ANCI is linked to ANCI (The Association of the Italian Municipalities) and has been member of EuroHealthNet since June 2015.
by Lorenzo Terranova
Context that Federsanità ANCI is working in
The economic crisis has had a huge and dramatic impact on the economic, social wellbeing and health of many Italians and foreign-born residents: per capita GDP fell to the level of 1998 and cuts were made to social and healthcare funds and programmes. Moreover, some reforms failed: the social funds did not provide assistance to vulnerable people but instead only to some “classes” of people. This led to people becoming impoverished. Health conditions were in fact one of the main reasons for this impoverishment – the system had to decrease payments to an assistant or nurse who would previously have provide assistance to an older person, and families had to subsidise the difference.
These factors drove the system towards an increase of inequalities in healthcare (both in terms of effective access and availability in some areas of the country), as well as in access to social services. Among other causal factors, the legal system is not geared towards reaching goals, and there was a freeze in hiring so the labour market closed off to many.
The healthcare and social systems have to face up to this new context. The only possible strategy is: (a) to strengthen linkages between healthcare assistance and social assistance; (b) to increase effectiveness and efficiency of the system. About 70% of healthcare expenditure is due to chronic diseases (COPD, diabetes) and that disproportionately affects older people, migrants, single mothers and many others social groups.
Federsanità ANCI goals
Federsanità ANCI has the following goals:
- To be a knowledge network to share experiences, understand where we are going, and to find reasonable solutions. The Italian healthcare system is region based. Thereare different and interesting experiences that are not often known about outside individual regions. Federsanità ANCI cannot benchmark these systems, but it can help to share knowledge and practice among network members. This proves to be a very useful tool for finding appropriate solutions.
- To go in depth about issues that could lead to better use of human and financial resources. It is important to focus on issues that could help the whole welfare system to offer better solutions. Federsanità ANCI has started working groups, which aim to study critical issues and find solutions to them:
- Patient profiling. Unfortunately, healthcare and social organisations face many difficulties in characterising their own patients/users (we have many socio-epidemiological studies, but a public service should be able to put a specific patient inside a demand map – e.g. the Kaiser Pyramid). Federsanità ANCI started a study on how collect and use different information as tools to plan personalised services.
- Corruption. According to the High Court on Public Accounts, about €6 billion is wasted every year as a result of corruption in the healthcare and social sectors. Corruption is harmful for both for public provision of services and for trust. It also contributes to creating and maintaining inequalities related to care. The fight against corruption involves using new tools, which can be discussed with stakeholders. The goal of Federsanità ANCI is to find innovative solutions to prevent corruption in the healthcare system.
- List and standardise prices for social services. At the moment, Italy lacks a national list of social and social/health services. Federsanità ANCI is involved in the working group that will define this list. The second step will be to start defining and fixing prices for each service. The lack of a national list, and large differences in prices for social and social/health services across regions, produce severe inequalities between different regions of the country. While some services are offered for free in certain regions, in other regions they may require co-payments or may not be available at all.
- To gather ideas and transform them into technical proposals. Many suggestions are transformed into proposals for regional and municipal decision making bodies.
Lorenzo is Head of the Research Department at Federsanità ANCI. He previously worked for the Italian Ministry of Treasury, Farmindustria (the Italian Association of Pharmaceutical Companies), FIASO (Italian Federation of Health Care Structures and Hospitals), and 4 Health Innovation (a consulting company). He teaches “Health Economics” at the postgraduate Medical School of Health Statistics at the University of Rome “La Sapienza”.