MEMBER'S CORNER
ITALY
The challenges of the Italian health system
“Over the last five years the Italian public health system had to face important challenges: limiting spending, not adequately addressing the inefficiencies of the "machine”, transferring as much as possible the action of the spending review on funding granted to accredited private parties and giving rise to a de facto rationing of the services provided to users. These situation is further evidenced by the trend of several phenomena:
the growing dissatisfaction with the health system in the home Region (rising to 32.2% in 2017, and even 51.3% in the South); the difficulty of finding reliable information when choosing the most suitable hospital for the patient ; the slight and/or lack of feeling of "being placed at the center" as patients; the inadequate link between the phase of hospital discharge and that of access to social assistance-post-hospitalization services; the repeated postponing and/or foregoing of care by people who needed it.
To deal with the problems that have gradually accumulated (and worsened), especially in the last 6-7 years, a set of reaction strategies have been enacted by patients and their families, these may include: recourse to accredited private hospitals or paid private clinics, as an alternative to public facilities (41% in the first case and 20% in the second case), most especially given the reduced waiting time for services and greater trust in the accredited hospital and doctors that work there; the use of hospitals in Regions other than the one in which they live, with reasons correlated to the higher quality of hospital services, the presence of trusted medical personnel and specializations that do not exist in the regional facilities, as well as due to long waiting lists; making use of accredited private hospitals as an alternative to public ones, awareness of the ability to do so without additional burdens for users having gradually increased (from 35.5% in 2009 to 39.3% in 2017), turning to hospitals located outside the home Region (by 31% -32% of the citizens interviewed) or even by seeking healthcare and hospital services at facilities in other countries of the EU (increased from 14.1% in 2013 to 18.5% in 2017). Finally, a fundamental strategy employed is that of out-of-pocket spending by Italian families. This expenditure has increased by 22.4% over the last 10 years, while total public health expenditure has risen by only 14.2% at current prices.
The capacity of the public hospital system to deal with its inefficiencies is still largely an issue that has not been adequately resolved (as is also attested to by an examination of the Hospital Centers' Financial Statements). All of the considerations make it possible to state that the Healthcare Agreement based on the principles of universality and inclusiveness, which we have enjoyed for almost forty years, is now significantly weakened and indeed is at risk of a serious breakdown. The truth is that the time has come to attempt a transition to a New Healthcare Agreement, while at present we are limited to intertwining the deterioration/rationing of services with the reactive behaviors that users are able to put in place.
In reality, we should take note of the situation and recognize the existence of a "gap" between the inevitable increase in current and future coverage needs and the need to continue to increase the relative public expenditure in a consistent manner. This brings us then to set forth an inevitable redesign scenario in order to more stably balance needs, on the one hand, and public resources, on the other.
All of this will therefore require rethinking our health and social welfare system which: on the one hand, should (hopefully) retain its universal and inclusive nature as much as possible for the most serious needs, and on the other hand, introduces a "responsibility commitment" for all of the parties involved, without exception: public system, insurance system, corporate representation system, workers' representation system, individual citizens and families. The adoption of this responsibility commitment is essential for the gradual construction of a New-Healthcare Agreement that must be held together by a three-fold bond.
The first of these is that which must tie public funding to the responsibility of the healthcare "machine" to undertake an in-depth restructuring and reorganization. Cost cutting alone is not enough, as has also clearly emerged from the experiences with debt rescheduling plans and commissioners, which have led to a deterioration and a rationing of services for patients. But this first bond also implies having full and detailed transparency of the financial statements as well as the levels of effectiveness of the care activities (by number and quality of services provided) so as to "free up" some additional resources to invest in innovation, restructuring/reorganization, and the incorporation of new personnel.
At present we are faced with a moving picture, but it is becoming increasingly important to reorder the responsibilities, roles and resources of the various parties, while avoiding solutions that are as extreme as they are unworkable in their conception such as, on the one hand the nostalgia for "old-fashioned social assistance" and, on the other hand, the aspiration for "completely privatized social assistance".
By Nadio Delai President of ERMENEIA. ERMENEIA is a company specialized in providing analytical and consulting activities to public and private clients.
FRANCE
Private Hospitals Trophies 2018
The 11th edition rewarded 9 private hospitals for their innovation and commitment to serve patient.
FHP (French Federation of Private Hospitals) presented Wednesday, December 12th its annual Trophies which reward outstanding initiatives implemented by private clinics and hospitals.
The winners were selected by a jury of recognized and independent personalities from the health sector in four categories:
- Innovative organization of the health care pathway (new category)
- Socially responsible clinic
- Patient relation
- Medical excellence
"Every year, it is with great emotion that I present these trophies," said Lamine Gharbi, president of FHP. "In fact, even if these trophies represent a reward, they are above all the recognition of the commitment of all our establishments to serve the 9 million patients they welcome every year. This commitment is made of competence, enthusiasm and a lot of work. It is the guarantor of the quality of the care provided in our 1030 private clinics and hospitals. It is a real sense of pride for me to highlight the institutions and teams that embody this ongoing mobilization of private hospitals, despite the difficulties sometimes encountered."
The winners
Category innovative organization of the health care pathway
- Winner: Clinique Provence Bourbonne (Aubagne) for the project "A Serious Game" involving patients in their rehabilitation in neurological reha centers. The goal of this "serious game" called S'TIM (esteem) is to help patients recover their cognitive and executive functions such as locating themselves in time and space, planning a task and adapting to a context.
Category socially responsible clinic
- Winner: Clinique de Miremont (Badens) for the project "Clinique de Miremont: from chaos to a beautiful renaissance, or how to recover performance through well-being at work". The goal of this initiative is to make the quality of life at work a fundamental value and a priority within the Clinique de Miremont to implement a culture of performance through well-being.
Category : Patient relation
- Winner: Clinique de l'Union (Saint-Jean) at Saint Jean for the project "Sensoriality at the heart of the parent-child relation in neonatology". The goal is to allow mother and child to live together harmoniously thanks to rooms equipped with two distinct spaces and with a material protecting the neurosensory development of the babies from noise disturbance, luminous and tactile aggressions. This architecture adjusts to the constraints related to medical care and / or neurosensory disability of the parents.
Category Medical excellence
- Winner: Hôpital Privé Jean Mermoz, (Lyon) for the project "Pancreatic surgery with robotic assistance: feasibility pilot study". The project aims to reduce the mortality / morbidity rate and improve surgical efficiency, through the development of minimally invasive techniques (laparoscopic and robotic surgeries).
Jury's Coup de Coeur
- Winner: Polyclinique du Cotentin (Equeurdreville) for the project "Physician recruitment campaign:" We are Med'in Cherbourg, and you? ". Launched on social networks, this campaign is carried out by the practitioners of the Cotentin Polyclinic and the Cotentin Public Hospital Center (CHPC) aimed at current and future medical colleagues: "We are Med'in Cherbourg, and you? ". This innovative initiative makes it possible, within the framework of a precious public-private cooperation, to present a dynamic city whose population is attached to its territory, taking advantage in particular of sea leisure activities for an exceptional quality of life, with doctors proud of their working tool and very satisfied with their practice conditions in Cherbourg. This campaign, which is part of a territorial dynamic, benefits from the support of local businesses.
MAJOR PRIVATE GROUPS IN EUROPE
SWITZERLAND
Hirslanden, the biggest private hospital group in Switzerland
|
What is the place of your hospitals group within the Swiss healthcare system?
Hirslanden is Switzerland's largest private hospital group and also the biggest medical service network. The Hirslanden Private Hospital Group consists of 18 hospitals in 11 cantons, many of which have an integrated outpatient surgery unit and a 24-hour emergency centre. The group also operates 4 outpatient clinics, 17 radiology and 5 radiotherapy institutes. The Hirslanden group has public service contracts in all of the cantons where Hislanden clinics are located, thus significantly contributing to the health care delivery of the Swiss population.
|
Interview with Urs Martin, head of Public Affairs
What are the latest news and projects in your clinic group?
A leading private hospital in Geneva - the Clinique des Grangettes - joined the group in September, strengthening Hirslanden’s presence in Switzerland. Our aim is to create interdisciplinary and cross-sectoral networks in order to maximize the benefits for patients.
To meet this goal, a high quality service level is essential, as attested by Hirslanden certifications and service contract agreements. The Klinik Hirslanden was for instance the first private hospital in Switzerland to successfully obtain the certification by the German Cancer Society for its centers specialized in breast and prostate cancers. Klinik Hirslanden was also the first private hospital in Switzerland to be accredited for strokes complex treatments.
Moreover, Hirslanden Private Hospital Group pays great importance to patient satisfaction, which is continuously monitored in all hospitals using the Press Ganey international measurement metrics. This year and for the first time, patient satisfaction results for all Hirslanden clinics have been published online.
What are the issues that most concern you in the coming years?
The ongoing evolution of the health policy framework will remain challenging in the coming years, especially since the consolidation of the healthcare sector in Switzerland is underway. Currently we are particularly busy with the shift in medical services from inpatient to outpatient care, as requested by our policy makers.
In your opinion, in which way does your group best contribute to public health in your country?
Hirslanden stands for first-class medical quality, ensured by highly qualified and experienced specialists. Interdisciplinary medical competence centers and specialized institutes enable optimal and individual treatments, even of highly complex cases. Outstanding certifications and awarded service contracts in the field of highly specialized medicine bear witness to the high quality standard.
What should be done to increase the proportion of private clinics in Europe?
This requires a clear political framework in the sense of a competition oriented health system. The decisive factor here is that both private and public hospitals have equal chances. In Switzerland, however, the multiple role of cantons leads to problematic conflicts of interest. Cantons operate public hospitals and are at the same time responsible for the supervision of all hospitals, the elaboration of the hospital planning and the cantonal hospital list*, the approval of tariffs and the planning of highly specialized medicine. This gives the cantons clear incentives to favor their own hospitals, thereby penalizing private hospitals, which ultimately leads to distortion of competition. Therefore, the multiple role of the cantons should be reconsidered.
* Health insurance companies reimburse a maximum of 45% of the price of a service, while the cantons pay the remaining 55%. However, to get the cantonal funding of 55%, a private clinic is required to be included on the cantonal hospital list.
|