Over the past year, the revision of “Ministerial Decree 70” on hospital standards, the regulation defining the qualitative, structural, technological and quantitative standards of hospital care, has mobilised the attention of the health world at all levels.
Given the scope of the document, as an eminently programmatic instrument, AIOP (Italian Association of Private Hospitals) published its position and the considerations arising from the technical hearing at the Ministry of Health.
“For the private hospital, the definition of standards for a rational design of hospital supply and for a territorial planning oriented towards criteria of quality, efficiency, safety and effectiveness, is a valuable and legitimate effort of the NHS: it is however fundamental that it is these criteria and not others that establish which structures are called upon to provide services of proven clinical effectiveness“, explains Barbara Cittadini, National President of AIOP.
AIOP considers it a priority that the selection of providers and thus their evaluation and remuneration be based on criteria that are exclusively oriented towards the care needs of patients and towards ensuring fair access to services of proven clinical effectiveness. Furthermore, the “public” character of health services on behalf of the citizen-users must be safeguarded, as well as the system of financing health services through general taxation.
Based on the analysis of the provision of minimum volumes of activity per service or clinical facility, the Association’s position paper suggests the need to rethink the accreditation system and the mechanism for allocating budgets to private facilities, which automatically set a ceiling on the services that can be provided within the NHS, regardless of their actual potential.
According to AIOP, reducing the qualitative heterogeneity of providers but, at the same time, strengthening their variety and functional specificity is an ambitious and difficult task, which must be pursued by avoiding drifts, assessing and managing the impact of quantitative requirements on our NHS, which is in fact divided into 21 distinct and poorly integrated health systems.
Observations and proposals for change include:
Bed allocation requirements:
- Revising the requirement that the allocation of acute beds should not be less than 60 beds, as a threshold for accreditation and signability of contractual agreements with private sector facilities;
While the logic of the standards is to rationalise the hospital network in order to improve the system’s ability to meet patients’ needs, the number of beds has no known association with the quality of care provided. The consequence is a compression of pluralism that penalises smaller, but perfectly functional and locally based private structures.
- A study carried out by AIOP in collaboration with Nomisma on the assessment of the impact – in terms of limiting access to care and induced health mobility – of the standards envisaged both in the current DM70 and in the draft revision, from the point of view of the patient-user;
- The difficulty of assessing the volumes of NHS private facilities, since these volumes are “imposed” by the budget allocation mechanism and are therefore not indicative of the real potential of the supply;
For the AIOP, the cost of rationalising supply on the basis of safety and clinical effectiveness criteria – as is clear from the premises of the DM70 itself – must not fall on the patient and his or her subjective capacity (economic and mobility) to go to the hospital structure considered “suitable”, if the search for quality is not to result in a simple rationalisation of the system to the detriment of patients’ health and right to care.
The risk – the AIOP continues – is to encourage patients to forego treatment and to widen, rather than reduce, inequalities based on geographical and socio-economic variables.
Network of birth points
- Safeguard and strengthen the Hub and Spoke network model – a common thread throughout the DM 70 and considered internationally to be the best system for ensuring safe and adequate perinatal care – also for childbirth care.
- Apply to all maternity units the safety standards of 24-hour care of two obstetric and two gynaecological staff units, an anaesthetist and a neonatologist, as well as the presence of sub-intensive care, as provided for in the 2010 State-Region agreement for first-level birth points.
According to AIOP, the safety of the mother and the unborn child in first level delivery points – i.e. maternity facilities that accompany pregnancies and physiological deliveries of more than 34 weeks of gestational age – should be pursued by making full use of the potential for risk management and promoting formalised protocols for referral to the appropriate care setting for the level of risk and rapid access to any facilities not present in first level delivery points (such as the transfusion centre, general intensive care unit, neonatal intensive care unit, multi-specialist consultations).
The Italian Society of Gynaecology and Obstetrics (SIGO), which insists on the centrality of continuity of care and the valorisation of the temporal network, also agrees, recalls AIOP.
Extract from articles published on AIOP website and media articles