Big Cuts to Hospitals and Beds in Molise, Lazio and Trentino [Italy]

CorriereDellaSerra.it ^ | 08 novembre 2012 | Margherita De Bac

[DeaconBenjamin]

ROME – Italy’s hospitals are to lose 30,000 beds as the scenario outlined in last summer’s spending review begins to take shape. Regions have until 31 December to indicate where the reductions will be made. In the upcoming three-year period from 2013 to 2015, the current average ratio of 4.2 beds per thousand residents will have to drop to 3.7. The total should include 0.7% set aside for rehabilitation and long-stay patients who no longer need acute care. Some regions, including Emilia Romagna, Veneto, Tuscany and Lombardy, have already begun to wield the axe while others have yet to start. Significantly, these are the regions with the biggest deficits and budget-balancing plans in place. Molise will have to make bigger cuts any other authority (-33.2%), followed by the autonomous province of Trento (-20.9%) and Lazio (-19.9%). The aim is to arrive at a more modern system through the key concepts of fewer hospitals (which are very expensive and create waste), more territory-based services and more appropriateness.

The underlying criteria are laid out in a framework for regulations on “Quality, Structural, Technological and Quantitative Standards in Hospital Care”. Unless there are new developments, it will be submitted for approval by the central-regional government conference next week. The document, which is ready, was drafted by the health ministry’s AGENAS agency for healthcare services, directed by Fulvio Moirano, which is also in charge of the performance evaluation plan for individual health structures.

It would be more correct to describe the programme as conversion, not cuts, because the beds lost will not be removed. Instead they will be used for other purposes, such as accommodation for the elderly or long-stay patients. The cuts will not be tiny – a bed here, two there – or adhere to the logic of mediation, particularly in universities. Entire carbon-copy departments, known today as complex operative units, will disappear on the basis of catchment area and performance studies. The aim is to offer patients a better service. The more experience a unit accrues, the safer it becomes, particularly for highly specialised procedures such as transplants, heart surgery and neurosurgery. Many areas have too many units working too little because they have to share out patients, thus compromising quality. Minimum quotas are now in place for some specialisations. Coronary bypass units, for instance, should carry out at least 150 ops a year. Yet in Rome, to take one example, only one heart surgery unit out of eight reaches this target while ten of Lombardy’s 18 units meet the criterion.

Giuseppe Zuccatelli, currently deputy special commissioner for health in Abruzzo, spoke on the issue at a conference organised in Rome by Meridiano Sanità on health in Italy during the economic crisis. He said: “Closing departments is not always a successful undertaking. There’s a lot of political resistance. You have to eliminate entire departments to comply with the ministry’s indication on beds. It’s the only way to achieve lasting results that are effective both economically and in terms of staff recovery. Nurses and auxiliaries can be used elsewhere and to cover for turnover”. In other words, the cuts will not be across the board, untargeted or driven by pressures. The regulation framework divides hospitals into three categories – hub, spoke and complementary – on the basis of size and structures. Emphasis is placed on bed occupancy rates, which should be around 80% to 90%. On a 30-bed ward, an average of at least 26 should be occupied. And that’s how the waste-trimming measures work.

[Huebolt]

As the lord high executioner o’bumhole said “Let them take a pill.”