Veneto Health System
Zeeland Denmark EU Office
Brussels, 11th May 2009
Daniela Negri
Summary
• Part 1
– National and Regional Health System
– Regional Health Care Resources
• Part 2
– Objective and Priorities 2007-2009
– Waiting List
• Part 3
– Partnership and networks
– EU Projects
– Contacts
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2
Part 1
– National and Regional Health Systems
– Regional Health Care Resources
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3
Veneto Region
•18.390 km 2
•4.8 million inhabitants
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4
Health devolution:
From 2001 new competences
for the regions
Italian Constitution: New Art.117:
All domains concerning human health pertain to
the legislative function of the Regions.
Regions are responsible to plan and provide
health and social services.
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Italian Health Care System
• Universal coverage, free of charge;
• Funded through general taxation;
• 3 level:- National:
» General objectives & fundamental principles
» LEA - Essential levels of care provision
» Regulatory function for drugs & medical equipment
- Regional:
» Management & organisation: target orientation,
delegating management to Local Health Authorities
(LHA) and structures;
» Coordination and control
» Financially accountable
» Legislative & administrative functions Planning
- Local:
» Management &delivery
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Veneto Region Social and Health Care System
Organization Chart
Minister for Health
Policies
Minister for Social
Policies
Secretary for Social and
Health Policies
Dep. Of
Prevention
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Dep. Of
Health
Care
Planning
Dep. Of
Economic
Resources
Dep. for
Hospitals
Dep. of
Social
Services
7
Veneto Health Care Model
1. Multi-tiered structure in the territory
2. Structural integration between local community
and hospital
3. Integration between social and health care
4. Delegating management to local health
authorities (LHA)
5. Fostering coordination between LHA, NGOs,
public authorities
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Veneto Region Health System:
Numbers and Figures
•
•
•
•
•
•
•
21 territorial LHAs (managing 60 hospitals)
2 public hospital trusts
1076 specialist health care service providers
1307 pharmacies
3600 general practicioners
250 residential home for the elderly
hospital beds in the public system are 19,429
(85.85% of the regional total) and 3,470 private
hospital beds (15,15%)
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The Veneto Region
is divided into
21 Local Health Authorities
(LHAs)
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10
Financing - I
• Regional Health System  Based on general taxation.
• The Government together with the Regions negotiates
annual quota for funding the regional systems.
• LHA global budget
- weighted capitation mechanism
- adjusted according to the historical spending
- additional compensation is given for cross-boundary
inter-regional flows;
• Hospital providers: fees for services ( DRG) ;
• GPs capitation.
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Financing - II
Percentage of total expenditure on health
according to source of revenue (2004)
OPP
19%
VHI
2%
OTHER
3%
TAX
76%
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Financing - III
Trends in health care expenditure in Italy
1988-2004 (billion € at 2000 GDP prices)
80
70
60
50
40
30
20
10
0
Indicators
1988
1990
1995
2000
2003
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
Trends in health care expenditure in Italy, 1988-2004
2004
Public
Total health expenditure
in per capita US$ PPP
1 195
1 391
1 535
2 049
2 266
2 424
Total health expenditure
as a percentage of GDP
7.7
7.9
7.3
8.1
8.4
8.7
Public expenditure on
health as a percentage of
total expenditure
77.6
79.1
71.9
72.0
73.7
75.1
Private expenditure on
health as a percentage of
total expenditure
22.4
20.9
28.1
26.5
24.9
23.6
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Private
13
Regional Investment in Health & Social Services
2008
• Regional budget allocation for Healthcare: € 7.2 Billion
• Regional investment allocated to the Social Sector:
For non selfsufficient,
mainly elderly
citizens and
other
vulnerable
population
groups
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For financing other
programmes:
€820 M
To provide
services to
drug addicts
home care for the
elderly;
support to families
with chronically-ill
dependent;
telehelp for
caregivers;
services for disabled
people 14
Veneto Region – Health Expenditure
AMORTIZATIONS AND
DEVALUATIONS
2%
FINANCIAL BURDENS EXTRAORD.BURDENS
0%
0%
OTHER COSTS
3%
HC GOODS
9%
NON HC RELATED GOODS
1%
REGIONAL HC SERVICES
12%
PERSONNEL COSTS
32%
PURCHASES OF NON HC
RELATED SERVICES
7%
EXTRA REGIONAL HC
SERVICES
2%
PRIVATE SECTOR SERVICES
31%
PUBLIC SECTOR SERVICES
1%
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Part 2
– Objective and Priorities 2007-2009
– Waiting List
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Health and Social Affairs Plan
2007-2009 (1)
Strategic Objectives:
A.
Better Implementation of Essential Level of Care Provision
•
•
B.
Increasing Prevention and Health Promotion:
•
•
•
•
•
C.
Reducing Waiting Lists
Reduction of costs maintaining high quality
Healthy life styles promotion
Increasing prevention
Promotion to a correct use of medical drugs
Promotion of policy addressed to family, adolescent, infants and
young people
Health and integration of immigrant people
Increasing Quality
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Health and Social Affairs Plan
2007-2009 (2)
D.
Renewing Health Care System
•
•
•
•
E.
Improving Research and Innovation:
•
•
•
F.
Better integration of providers and hospitals
Interoperability among health systems, including emergencies
units
Better collaboration between universities and health providers for
training
Improving utilization of smart-cards
Increase biomedical and health research;
Increasing use of technology (HTA, diagnosis, …)
Use of innovative managerial and organization model
Citizenship Participation:
•
•
•
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Freedom in choosing health care providers
Involvement of Third Sector
Better communication
18
Economic Pressures on Veneto
Regional Health and Social System
• Impact of Technologies:
– Rising costs due to technological innovation
• Demographic and Social Changes:
– Ageing population
– Patient mobility: tourists, immigrants, long
term residents
• Lack of health professional (mainly
paediatricians and nurses)
– Waiting Lists
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Tackling a challenge:
Reducing waiting lists…
National Plan for Reduction of Waiting Lists 2006-2008
Oblige Regional Authorities to:
• Define a Regional Work Plan to reduce waiting lists
• Define the maximum number of waiting days for each disease
category
• Define financial consequences for unfulfilling Regional Authorities
Regional Law DGRV 300/2007 and
“Intramoenia” experience
Local Health Authorities Implementation
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Reducing Waiting Lists… (2)
Regional Law DGRV 300/2007
4 main objectives:
1. Definition on each prescription the specialistic visit
category and maximum of waiting days allowed per
category
2. Definition of 2007 targets
3. Implementation of a monitoring system
4. Evaluation of Local Health Authority Directors on the
basis of the Waiting List Plan’s results
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Reducing Waiting Lists… (3)
DGRV 300/2007 - Objective 1 :Definition on each prescription the
specialistic visit category and maximum waiting days allowed per
category
Hospital Admission
Category
Description
Maximum
Waiting days
A
disease tending to become emergency
30 days
B
disease with intense pain or serious disability,
not tending to become emergency
60 days
C
disease with slight pain, without relevant
disability, not tending to become serious
180 days
D
disease without pain and disability
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12 months
22
Reducing Waiting Lists… (4)
DGRV 300/2007 - Objective 1 :Definition on each prescription the
specialistic visit category and maximum waiting days allowed per category
Examination
Category
Category Description
A
disease tending to become
emergency
B
C
D
Service
Maximum Waiting days
General examination
10 days
Specialistic examination
10 days
disease with intense pain
or serious disability, not
tending to become
emergency
General examination
30 days
Specialistic examination
60 days
disease with slight pain,
without relevant disability,
not tending to become
serious
General examination
180 days
Specialistic examination
180 days
General examination
180 days
Specialistic examination
180 days
disease without pain and
disability
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Reducing Waiting Lists… (5)
DGRV 300/2007 - Objective 2: Definition of 2007 targets
Physician
Office
service
Category
31/12/2007
31/12/2008
A
80%
90%
B
70%
80%
C
90%
100%
D
A
Hospital
Admission
100%
B
50%
90%
C
50%
80%
D
Oncology
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70%
100%
100%
24
Reducing Waiting
Lists… (6)
“It’s time to care”
Advertising campaign to
inform citizens on their
rights on waiting time for
care
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Reducing Waiting Lists… (7)
Intramoenia experience:
• Possibility for patients to be cared in a public structure in a
private visit by a private specialistic physician;
• Public Service Fee < Intramoenia Fee > Private Fee;
• Guarantees citizens’ freedom of choice;
• Contributes to reduce waiting lists
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Part 3
– Partnership and networks
– EU Projects
– Contacts
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Representative Offices of the Veneto Region
Venice
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28
International Health and Social
Affair Office activities in Venice
• Development of joint programmes with the WHO
• Health care emergency programmes
• Interregional coordination with the Italian
Ministry of Health, the Foreign Affairs Ministry
and the Italian Red Cross
• Organisation of study visits of regional
delegations
• Organisation of workshops
• Twinning initiatives with the regions of candidate
member states
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Brussels Office
• Regional participation in EU health care
policy development
• Monitoring of EU public health activities
and initiatives
• EU funded projects
• Training and information activities on EU
topics
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Participation in international
networks
• Regions for Health Network
• Alpe-Adria Working Community
• European Observatory on Health
Systems and Policies
• ERRIN
• EUREGHA
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WHO REGIONS FOR HEALTH NETWORK
•Flemish Community
•Varna
•Northern Bohemia, Northern Moravia
•Lower Saxony, North Rhine- Westphalia
•Bács Kiskun, Györ Monson Sopron Szabolcs-Szatmár
•Northern Region
•Emilia-Romagna, Veneto, Sicily
•Kaunas
•Rogaland
•Silesia
•Madeira
•Vologda
•Catalonia, Extramadura, Valencia
•Västra Götaland, Östergötland
•Ticino
•North West England, Wales
Belgium
Bulgaria
Czech Rep
Germany
Hungary
Israel
Italy
Lithuania
Norway
Poland
Portugal
Russia
Spain
Sweden
Switzerland
United Kingdom
http://www.euro.who.int/RHN
Alpe Adria Working Community
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The European Observatory on
Health Systems and Policies
• Partnership:
– International Organisation: the WHO Regional Office for Europe,
the European Investment Bank, the Open Society Institute, the
World Bank,
– National Governments: Belgium, Finland, Greece, Norway,
Spain and Sweden,
– Regional Government: Veneto Region
– Research Institute: the London School of Economics and
Political Science (LSE), the London School of Hygiene &
Tropical Medicine (LSHTM), CRP-Santé Luxembourg
• Aim: support and promote evidence-based health policymaking through comprehensive and rigorous analysis of
the dynamics of health care systems in Europe.
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ERRIN
• Collect and give pre-information on FP7,
providing ERRIN network with a technical
background in FP7;
• Discuss and circulate methods, tools and good
experiences on how regions tend to identify and
develop regional development strategies;
• Develop proposals to open consultations;
• Networking.
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EUREGHA
Aims to:
• Share information and experiences;
• Forum for EU institutions and local / regional
(health) authorities;
• Raise awareness of local / regional dimension
and enhance local / regional influence on EU
health initiatives;
• Provide expert knowledge and added value to
EU institutions;
• Cooperate with other health networks and
NGOs.
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European Health Projects
managed by Veneto Region
• 20 running project
• 2 in negotiation phase (Call PH 2008)
• 2 in evaluation (Call FP7 2008)
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European Health Projects
The Budget
Progetti
in gestione
Total Budget
in €
Cofinanc. CE
To RV in €
Cofinanc. RV
in €
€EC/
Budget
Project
RGV
Health
13
50.949.137€
2.183.102€
3.487.780€
38%
Social
Affairs
6
1.577.823€
139.205€
155.081€
47%
3.300.000€ of contribution in kind
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38
EU Projects - Health
Oggetto
Programma
Leader
Ref.
RGV
Costituire un
consorzio europeo per
l’azione sul controllo
dei determinanti socioeconomici della salute
Salute
Pubblica Call
2006
Istituto
nazionale
di salute
pubblica
della
Repubblica
Ceca
SRSSI
SIALON
Lotta all'HIV attraverso
un sondaggio tramite
utilizzo di kit
sperimentali
Salute
Pubblica 2007
Regione
Veneto
CHI-CYTOBACCO
Costruire una rete di
partner europei che
collaboreranno
insieme per affrontare
le questioni legate al
controllo del
tabagismo.
Salute
Pubblica Call
2006
Liverpool
Primary
Care Trust
(UK)
Titolo
1
2
3
DETERMINE
11th May 2009
Budget
totale
in €
Cofina
nz. CE
alla RV
in €
Cofina
nz RV
in €
1.899.000
8.476
12.000
CRRPS ULSS 20
Verona
714.451
152.715
126.720
Azienda
USL 19
Adria,
Finessi
699.414
28.473
63.890
39
EU Projects - Health
4
5
6
Titolo
Oggetto
Program
ma
Leader
Ref.
RGV
eTen –
call 2006
Regione
Veneto
HEALTH
OPTIMUM II
Definire uno standard
organizzativo/funzional
eper l’erogazione di
prestazioni sanitarie a
distanza e sviluppare
delle applicazioni di
telemedicina
USSL 9
– Treviso
Ufficio
Bruxelle
s:
Ronfini e
Motta
Salute
Pubblica
Call 2006
“HEALTHY
REGIONS
Promuovere
investimenti pubblici in
campo sanitario nelle
regioni attraverso una
migliore identificazione,
governance e uso
strategico delle
competenze sanitarie
regionali.
South
Denmark
European
Office
eTen –
call 2006
NETC@RDS
Estensione della
versione sperimentale
della Tessera
elettronica Europea
Assicurazione Malattie
Sesam
Vitale EIG
(Francia)
11th May 2009
Budget
totale in €
Cofinanz
. CE alla
RV in €
Cofinanz
RV in €
19.403.589
1.615.000
2.566.000
CRRPS*
- USSL
20
Verona
1.127.125
72.062,99
67.268
USSL 13
Dolo
Mirano
15.334.380
102.986
461.823
40
EU Projects - Health
7
8
9
Titolo
Oggetto
Progra
mma
Leader
Ref
RGV
Budge
t totale
in €
eTen – call
2006
AOK
Rheinland
Hamburg
USSL 10
Veneto
Orientale
e ULSS
13 Dolo
Mirano
1.900.018
18.522
18.523
TEN 4
HEALTH
Testare un servizio di
interoperabilità delle
carte elettroniche
della salute
Salute
Pubblica
Call 2006
FICT
Federazio
ne Italiana
Comunità
Terapeutic
he Roma
Ufficio
prevenzi
one delle
Devianze
548.227
34.500
36.714
SEID
Produrre un catalogo
trasnazionale delle
possibilità di
intervento su
prevenzione, cura,
terapia e l’inclusione
sociale tra i giovani
per
Salute
Pubblica
2004
Istituto
Superiore
di Sanità
(Italia)
989.900
51.924
60.200
VENICE
Armonizzare i dati
riguardanti le
infezioni nosocomiali
e la resistenza agli
antibiotici in Europa
11th May 2009
Cofina Cofina
nz. CE nz RV
alla
in €
RV in
€
41
Eu Projects - Health
1
Titolo
Oggetto
Progr.
Leader
REF
RGV
Tot.
Budget
Sanità
Pubblica
2005
DACETH
A
Dir.Piani
Progra
mmi
SocioSanitari
3.233.858
EUnetHTA
Rete europea per la
valutazione
dell’impatto delle
tecnologie sulla
salute
Euregio II
Sviluppo di strategie
per l'offerta di
servizi sanitari
trasfrontalieri
Sanità
Pubblica
2006
North
Rhine
Westfalia
INFORM
Lotta all'obesità nei
bambini e
adolescenti
Sanità
Pubblica
2006
Ospedale
di Villach
7PQ –
Health –
Call
09/07
EHMA
PROMET
3
HEUS
Health Professional
Mobility in the
European Union
Study
0
1
1
1
11th May 2009
CRRPS
Cof
CE a
RGV
Cof
RGV
17.490
25.681
0
0
2.181.386
28.851
32.160
2.917.789
52.100
16.800
42
EU Projects – Social Affairs
Titolo
Oggetto
Programma
Leader
Ref RGV
1
ESN European
Social
network
Individuazione di nuovi
indicatori europei per
politiche sociali contro la
povertà e l'esclusione
sociale
Azione "Finanziamento reti attive
nella lotta contro la povertà e
l'esclusione sociale - DG
Occupazione & Affari Sociali
European
Social network
(UK)
DirezionUe
Servizi Socilai
270.585,00
12.000,00
4.500,00
2
DEFT
Elaborazione di un
modello comune di
intervento per operatori
del settore
Leonardo da Vinci - Direzione
Generale "Istruzione e Cultura"
Comune di
vasteras
(Svezia) (N.B.:
partenariato
ENSA)
Osservatorio
regionale per
l'Infanzia e
l'adolescenza ULSS 3
399.405,00
58.500,00
43.875,00
3
PERCEN
TAGE
Creazione di uno
strumento formativo
informatico per
formazione degli
operatori sanitari e sociali
Leonardo da Vinci - Direzione
Generale "Istruzione e Cultura"
Contea del
Surrey (UK)
(N.B.:
partenariato
ENSA)
Direzione
Servizio
Anziani e
Disabilità ULSS Rovigo
414.000,00
30.494,00
10.165,00
4
EHLE
Creazione di un kit
formativo pergli
operatori impegnati
nell’educazione alla
salute degli anziani”
Grundtvig
Regione del
Veneto
OPNE
DOOR
Interventi a favore di
giovani a rischio di
esclusione nell'aree
metropolitane
Youth in Action DG
"Istruzione e Cultura"
Regione
veneto
Osservatori
o Regionale
Infanzia
Adolescenti
Giovani e
Famiglie
DESIGN
FOR ALL
Corsi di formazioni
rivolti ad architetti e
autorità locali,
nell’ambito della
tematica
dell’accessibilità.
Leonardo da Vinci
Partnerships
Conseil
général du
Val-deMarne
Direzione
regionale
Servizi
Sociali
6
11th May 2009
Comune di
Padova +
ULSS16
Budget
totale
343.256,00
150576,57
COF CE
28.731,00
9480,12
COF RVE
73.332,00
23209,19
43
International Health and Social Affairs Office
Palazzo Cavalli Franchetti
San Marco, 2847 - 30124 Venezia
Tel. 041 2791426-7
Fax. 041 2791366
[email protected]
[email protected]
11th May 2009
Avenue de Tervueren, 67
1040 Brussels
Tel +32 2 7437025 – 22 - 20
Fax +32 2 7437019
[email protected]
[email protected]
44
Thanks
For Your Attention
11th May 2009
45