Fewer beds, fewer staff, increasingly complex care services. The 95 Italian hospitals, the pride of the National Health Service and the realm of technology and high specialization, work better, but cost more. The updated check on the state of health of public health structures of excellence has just been traced by the Assr (Agency for Regional Health Services) in a study anticipated in the latest issue of the weekly «Il Sole-24 Ore Sanità »: between 2003 and 2004 – the last year surveyed – the cost of a day of hospitalization increased by 5.8 per cent, the cost per bed by 9.16 per cent, the costs per service on average by 5.4 per cent.
On balance, almost 900 million of increased spending from one year to the next. All of this without considering the costs of the 2004-2005 contract renewals which should weigh a further 3% on the budget of the public health agencies (about 450-480 million euro, considering all the effects from the entry into force of the agreement up to today).
Overall, in 2004, the 95 NHS structures of excellence (two less than the previous year due to the merger of two companies from the Marche region) spent 16 billion (almost 20% of the entire 2004 healthcare expenditure), of which 60% (9.7 billion) on staff alone; used 79,892 hospital beds (37% of the total, with a decrease of 3,033 hospital beds 3.6%) and 225,035 personnel (also in this case approximately 37% of the total: 1.13% less than the previous year), of which 39,660 doctors and 93,188 nurses.
The quality and appropriateness of the services guaranteed to the patients also grew hand in hand with the costs: with a total of 4,057,405 treatments (ordinary and day hospital admissions) the company hospitals guaranteed over 32% of total NHS discharges, significantly higher than the usual performances.
The decrease in ordinary hospitalizations (35,200 less), the simultaneous increase in cases resolved in day hospital (55,111 more: 32.50% of the total, against 31.29% in 2003), the decrease in beds and the increase in the complexity of hospitalizations are the indicators that testify - according to the Assr - to the "slow but progressive improvement in the organizational efficiency of the structures".
However, as always, efficiency and costs proceed at a differentiated pace in the different areas of the country. The average cost per day of hospitalization is 674 euros, but it ranges from 932 euros in Piedmont to 593 euros in Liguria, even if the latter has a decidedly higher incidence of "complex" hospitalizations.
However, the data should not be understood simplistically as an alarm bell for an anomaly: the different specialties ensured by the structures weigh in different ways on the costs. This is demonstrated, for example, by the relative data Cto-Crf Maria Adelaide of Torin has the most expensive day of hospitalization ever (1,144) euros), mirror of the complex specialization on traumatological cases; second in the standings is another Turin hospital, the generalist San Giovanni Battista Molinette (1,138 euros) and the regional oncologist of Rionero in Vulture in Basilicata (1,088 euros).
Vittorio Emanuele of Gela (Sicily) proposes the cheapest day with 402 euros, followed by S. Antonio Abate of Gallarate (414) and Bolognini of Seriate (477 euros), both in Lombardy.
The profile is different as far as rigu
