The requests from the citizens made to the Italian National Health Services (INHS) are deeply modified in the last decades. Some of the factors that have led these changes are: epidemiological, social, demographic transition and the economic-financial crisis, implemented since 2009, which has been characterised not only Italy but also most of the Occidental Country. Society is becoming ever more complex: birth rate is dropping, family units are less copious and population is ageing and facing chronic diseases that require health long-term care. Expectations are increasing toward care services to which has demanded to be constantly the lead and to have greater chance of success thanks to significant technological biomedical development. Also emerge the request to maintain/realise a balanced health care in which, by eliminating redundancies, we guarantee sustainability, equity and universality. Based on these preconditions, it is clear the requirement of INHS transformation in a way that involve all the system and all the actors who have been a part of it so that the services offered could be always high-quality, effective, efficient, safe and focused on the patient. The change needs to be promoted nationwide through ministerial guide that help every single regional institution to begin the process, starting from hospital sector. This work aims to examine the Decree of Ministry of Health 2 April 2015 n. 70, “Regolamento recante definizione degli standard qualitativi, strutturali, tecnologici e quantitativi relativi all’assistenza ospedaliera” trying to achive the elements that could help to improve the NHS renovation. The Regulation establishes standards for hospitals: it makes a classification according to catchment area; the clinical governance’s implementation is required as management model to guarantee high-quality care services; it defines number of hospital beds, average length of stay in hospital, employment and utilization rate of hospital beds and in the end it introduces the criterion “volume and outcome” as a new valuation standard for hospitals and health care activities. The Decree-Law proposes a new hospital model based on intensive care and health care complexity that carries out its activity as an integral part of health-care system built on a logic network. Integration of services and long-term care become the strengths through which satisfy health need of the users. The Regulation has proved to be a complex document of health care organisation in which methods, models and standards demonstrate to be the main points also in other organisation (health care system and/or hospitals) to promote better services. Moreover, also some limits emerge: absence of proper monitoring authorities and the slowness of implementing arrangement. Although some standard should be better defined through technical panel set up by the Ministry of Health, the implementation of legislation guarantee working tool to regional institution to promote Italian NHS transformation respecting need of people.
Le richieste fatte dai cittadini al Servizio Sanitario Nazionale (SSN) italiano sono profondamente mutate negli ultimi decenni. Tra gli elementi che hanno determinato questi cambiamenti vi sono: la transizione epidemiologica, sociale, demografica e la crisi economico-finanziaria in atto dal 2009 che hanno caratterizzato non solo l’Italia, ma gran parte dei Paesi Occidentali.La società si mostra sempre più complessa: diminuiscono le nascite, i nuclei familiari sono meno numerosi, la popolazione invecchia e si trova ad affrontare patologie croniche che richiedono assistenza sanitaria continuativa. Crescono le aspettative verso i servizi di cura ai quali è richiesto di essere costantemente all’avanguardia e di avere maggiori possibilità di successo grazie al forte sviluppo tecnologico biomedicale. Emerge anche la richiesta di mantenere/realizzare un sistema sanitario equilibrato in cui, eliminando gli sprechi, si garantisca sostenibilità, equità e universalità.Da queste premesse appare evidente la necessità di trasformare il SSN in modo tale da coinvolgere tutto il sistema e tutti gli attori che ne fanno parte affinché i servizi offerti siano sempre di qualità, efficaci, efficienti, sicuri e centrati sul paziente. Il cambiamento deve essere promosso su tutto il territorio nazionale attraverso una guida ministeriale che aiuti le singole realtà regionali a dare il via al processo, a partire dal settore ospedaliero.L’elaborato si propone di analizzare il Decreto del Ministero della Salute 2 aprile 2015 n. 70, “Regolamento recante definizione degli standard qualitativi, strutturali, tecnologici e quantitativi relativi all’assistenza ospedaliera” cercando di cogliere quegli elementi che possono contribuire al rinnovamento del SSN. Il Regolamento stabilisce standard per le strutture ospedaliere: le classifica in base al bacino d’utenza; richiede l’implementazione della clinical governance come modello di gestione per garantire la qualità dei servizi offerti; definisce il numero di posti letto, la degenza media, il tasso di occupazione e di utilizzo dei posti letto regionali e infine introduce il criterio “volume ed esiti” come nuovo parametro di valutazione per le strutture e per le attività ospedaliere. Il Decreto propone un nuovo modello di ospedale basato sull’intensità di cura e sulla complessità assistenziale cui si richiede di svolgere la sua attività all’interno di un sistema sanitario implementato attraverso una logica a rete. L’integrazione dei servizi e la continuità assistenziale divengono i punti di forza, attraverso i quali soddisfare i bisogni di salute degli utenti.Il Regolamento si è dimostrato essere un complesso documento di programmazione sanitaria i cui metodi, modelli e standard si sono rivelati elementi chiave anche in altre realtà (sistemi sanitari e/o strutture ospedaliere) per la promozione di un miglioramento dei servizi. Emergono peraltro anche alcuni limiti: la mancanza di organi preposti al controllo e la lentezza delle modalità di applicazione. Sebbene alcuni criteri dovranno essere meglio definiti tramite tavoli tecnici, istituiti presso il Ministero della Salute, l’attuazione della normativa potrebbe garantire alle istituzioni regionali strumenti per la trasformazione del SSN rispettando i bisogni della popolazione.
Il regolamento per gli standard di assistenza ospedaliera
MASSERONI, VERONICA
2014/2015
Abstract
The requests from the citizens made to the Italian National Health Services (INHS) are deeply modified in the last decades. Some of the factors that have led these changes are: epidemiological, social, demographic transition and the economic-financial crisis, implemented since 2009, which has been characterised not only Italy but also most of the Occidental Country. Society is becoming ever more complex: birth rate is dropping, family units are less copious and population is ageing and facing chronic diseases that require health long-term care. Expectations are increasing toward care services to which has demanded to be constantly the lead and to have greater chance of success thanks to significant technological biomedical development. Also emerge the request to maintain/realise a balanced health care in which, by eliminating redundancies, we guarantee sustainability, equity and universality. Based on these preconditions, it is clear the requirement of INHS transformation in a way that involve all the system and all the actors who have been a part of it so that the services offered could be always high-quality, effective, efficient, safe and focused on the patient. The change needs to be promoted nationwide through ministerial guide that help every single regional institution to begin the process, starting from hospital sector. This work aims to examine the Decree of Ministry of Health 2 April 2015 n. 70, “Regolamento recante definizione degli standard qualitativi, strutturali, tecnologici e quantitativi relativi all’assistenza ospedaliera” trying to achive the elements that could help to improve the NHS renovation. The Regulation establishes standards for hospitals: it makes a classification according to catchment area; the clinical governance’s implementation is required as management model to guarantee high-quality care services; it defines number of hospital beds, average length of stay in hospital, employment and utilization rate of hospital beds and in the end it introduces the criterion “volume and outcome” as a new valuation standard for hospitals and health care activities. The Decree-Law proposes a new hospital model based on intensive care and health care complexity that carries out its activity as an integral part of health-care system built on a logic network. Integration of services and long-term care become the strengths through which satisfy health need of the users. The Regulation has proved to be a complex document of health care organisation in which methods, models and standards demonstrate to be the main points also in other organisation (health care system and/or hospitals) to promote better services. Moreover, also some limits emerge: absence of proper monitoring authorities and the slowness of implementing arrangement. Although some standard should be better defined through technical panel set up by the Ministry of Health, the implementation of legislation guarantee working tool to regional institution to promote Italian NHS transformation respecting need of people.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/120465