Each year, the Italian Association of Private Hospitals (AIOP) analyses data at national and regional levels to assess the level of quality of health services by comparing public and private providers in the Italian national health system.
Italy has a solid information system, managed by the Ministry of Health, a large database containing information on every hospital activity of every patient entering and leaving public and private hospitals.
The national and regional federations of Italian private hospitals (AIOP) decided to use this data to build an algorithm to continuously evaluate the quality of the whole system. This programme not only provides an overview of the activity of the private sector, but also assesses the equalities and inequalities of the system.
Italian health system
The majority of Italy’s public health system is financed through the collection of a corporate tax called IRAP. Alongside with public hospitals, accredited private hospitals are contracted to provide health care. 44% of hospitals of the National Health Service and 70% of the hospital beds are public. 56 % of other hospitals are private (35% are AIOP accredited private hospitals).
The National Evaluation Outcomes Programme (PNE). It aims to assess quality, appropriateness and safety of healthcare services provided by the National Health System, as well as equity of access to such services. 177 indicators are analyzed in relation to 9 clinical areas.
DM 70 Regulation establishing the qualitative, quantitative, structural and technological standards relating to hospital care.
Every year, AIOP analyzed PNE results comparing public and private hospital care service quality, in relation to those standards defined by clinical evidence and DM 70.
Three main raisons:
- overcome the stigma of being a private provider within the NHS;
- shift the focus from the legal nature – whether private or public – of NHS hospitals to the quality of the services provided and the equity of access to such services with evidence for efficacy, effectiveness and safety. Healthcare services should be delivered by those providers which guarantee the highest quality;
- offering to its Associates all the information and the tools useful for the continual monitoring of the degree of compliance achieved for quality and quantity requirements or standards.
Private hospitals have a better overall performance when we compare them to public hospitals. The higher quality of private hospitals in Italy is due not only to the higher percentage of high-quality hospitals, but also to the lower percentage of low-quality hospitals, again compared to the public component. For example, in the cardiovascular sector, 65% of private hospitals are high quality hospitals, compared to 47% in the public sector, 13% of low-quality hospitals are private and 15% in the public sector. The maternity sector is the only sector where the performance in Italy of private hospitals is worse than that of public hospital.
But what we wanted to emphasise in this analysis is the extreme heterogeneity that we find. Heterogeneity here of course means inequality within national services. Inequality is one of the failures of a regional health system because it directly affects the rationale of the public interest for the market. To reduce the gap, AIOP advocates for equal standards of public and private providers, in order to achieve higher overall quality across the territory. Quality assessment is a very difficult thing. Some indicators are relevant, such as the mortality rate, others are less meaningful.