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ITALY<br />

Organization of the Health System in Italy<br />

Parliament<br />

Administration and Planning Flows<br />

Government<br />

Contractual agreements<br />

Ministry of<br />

University<br />

and Scientific<br />

Research<br />

Universities and<br />

clinical departments<br />

Teaching Hospitals<br />

Public pharmacies<br />

Health care district<br />

Ministry<br />

of Health<br />

Public Health Department<br />

National Institute<br />

of Public Health<br />

Regional<br />

Government<br />

Mental Health Department<br />

Agency for<br />

Regional Health<br />

Care Services<br />

National Health<br />

Council<br />

Research Hospitals<br />

(IRCCS)<br />

Public Hospital<br />

Enterprises<br />

Local Health Units<br />

Nursing homes and skilled<br />

nursing facilities<br />

LHU managed hospitals<br />

National<br />

Pharmaceutical<br />

Agency<br />

Private pharmacies<br />

General<br />

practitioners and<br />

paediatricians<br />

Private accredited<br />

hospitals<br />

Private accredited<br />

specialists<br />

Source: A. Donatini, Emilia-Romagna Regional Health Authority, 2014.<br />

Payment rates for hospital and outpatient specialist care are determined by each region, with national rates<br />

(determined by the Ministry of Health) as a reference.<br />

Some regional governments have established agencies to evaluate and monitor health care quality and to<br />

provide comparative effectiveness assessments and scientific support to regional health departments (see<br />

below). Regional governments periodically sign with the national government “Pacts for Health” linking<br />

additional resources to the achievement of health care planning and expenditure goals (see below).<br />

Safeguarding of patients’ rights has not been uniform and has depended on the level of effort of individual<br />

regions. Regions have implemented different models of empowerment: some through standing committees,<br />

which include members from citizens’ associations, as an institutional means of patient involvement, while others<br />

have emphasized systematic patient satisfaction surveys.<br />

Each public institution has an office for public relations (Ufficio Relazioni con il Pubblico) providing information<br />

to citizens and, in many cases, monitoring quality of services from the citizen’s point of view.<br />

What are the major strategies to ensure quality of care?<br />

National and regional governments, responsible for upholding quality, ensure that services included in the<br />

essential levels of care are provided and waiting times are monitored. Several regions have introduced programs<br />

for prioritizing delivery of care on the basis of clinical appropriateness of services prescribed and patient severity<br />

102<br />

The Commonwealth Fund

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