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Country profiles of health system responses to the crisis | Italy 417 • Reduction of NHS spending on public services contracts by 10% compared with 2012 (2013). • Mandated public hospitals to make purchasing requests through the National Purchasing Agency for Medical Goods and Services (2012). • Expenditure on medical devices reduced leading to reductions in Ministry of Health spending: àà reduction of €22 million in 2013 (Health Ministry's budget planned for 2013 was €278 million); àà reduction of €30 million in 2014; àà reduction of €35 million projected for 2015. Overhead costs: restructuring the Ministry of Health and purchasing agencies • No response reported. Provider infrastructure and capital investment • The government imposed a reduction in the number of hospital beds: 3.7 beds per 1000 population (down from 4 beds per 1000), of which 0.7 are for rehabilitation and long-term care (2012). It also imposed a reduction of the hospitalization rate from 180 per 1000 inhabitants to 160, 25% of which should be in day hospitals (2012). All targets were to be achieved by 30 November 2012. Priority setting or protocols to change access to treatments, coordination of care and patterns of use • The government sought to improve coordination of care by requesting the development of GP group practices, integration between hospital and primary care services and adoption of policies aimed at shifting patients from inpatient hospital care to day-hospital care or to community/home care (2012). Waiting times • Introduction of a range of policies to improve timely access to services, including the introduction of priority groups and specific diagnostic–therapeutic pathways with the involvement of GPs, volume controls for outpatient care by priority group, increased capacity through agreements with NHS providers, identifying facilities with guaranteed maximum waiting times, direct purchasing of extra visits and tests from private providers by local health units, activating central booking centres, penalties for patients who do not keep appointments and making user charges payable prior to accessing care (introduced with the National Health Plan (Piano Sanitario Nazionale)
418 Economic crisis, health systems and health in Europe: country experience 2006–2008 and further defined by National Plan for the Management of Waiting Lists (Piano Nazionale Gestione Liste d'Attesa) 2010–2012). Health promotion and prevention • Minimum age for purchasing tobacco and alcohol raised to 18 (2012).
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Economic crisis, health systems and
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The European Observatory on Health
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Keywords: DELIVERY OF HEALTH CARE E
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vi Economic crisis, health systems
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viii Economic crisis, health system
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List of abbreviations ACS Health in
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List of tables and figures Tables P
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xiv Economic crisis, health systems
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xvi Economic crisis, health systems
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xviii Economic crisis, health syste
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xx Economic crisis, health systems
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xxii Economic crisis, health system
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xxiv Economic crisis, health system
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xxvi Economic crisis, health system
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Acknowledgements This book represen
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Preface This book maps health polic
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Part I Country case studies
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4 Economic crisis, health systems a
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10 Economic crisis, health systems
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Chapter 4 The impact of the crisis
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Chapter 4 | The impact of the crisi
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Albania Genc Burazeri and Enver Ros
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Country profiles of health system r
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Austria Thomas Czypionka and Maria
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Azerbaijan Fuad Ibrahimov Economic
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Bulgaria Antoniya Dimova and Mina P
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Cyprus Elisavet Constantinou and Ma
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Czech Republic Tomáš Roubal and J
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Page 404 and 405: Estonia Triin Habicht and Mall Lein
Page 408 and 409: Finland Jan Klavus and Lauri Vuoren
Page 412 and 413: France Karine Chevreul, Karen Berg
Page 420 and 421: Germany Klaus-Dirk Henke and Wilm Q
Page 434 and 435: Iceland Sigrún Gunnarsdóttir and
Page 438 and 439: Ireland Anne Nolan and Steve Thomas
Page 444 and 445: Israel Bruce Rosen and Amir Shmueli
Page 452 and 453: Kazakhstan Ninel Kadyrova and Tata
Page 458 and 459: Latvia Uldis Mitenbergs and Maris T
Page 470 and 471: Malta Natasha Azzopardi Muscat Econ
Page 478 and 479: Montenegro Ratka Knežević Economi
Page 486 and 487: Norway Anne Karin Lindahl and Jon M
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The Russian Federation Elena Potapc
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Serbia Vukasin Radulovic Economic t
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Spain Enrique Bernal-Delgado, Sandr
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Switzerland Alberto Holly and Phili
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Tajikistan Ghafur Khodjamurodov Eco
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Ukraine Valeria Lekhan and Mariia T
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