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OECD Reviews of Health Care Quality: Italy 2014

Raising Standards

image of OECD Reviews of Health Care Quality: Italy 2014

This report reviews the quality of health care in Italy, seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. Italy’s indicators of health system outcomes, quality and efficiency are uniformly impressive. Life expectancy is the fifth highest in the OECD. Avoidable admission rates are amongst the very best in the OECD, and case-fatality after stroke or heart attack are also well below OECD averages. These figures, however, mask profound regional differences. Five times as many children in Sicily are admitted to hospital with an asthma attack than in Tuscany, for example. Despite this, quality improvement and service redesign have taken a back-seat as the fiscal crisis has hit. Fiscal consolidation has become an over-riding priority, even as health needs rapidly evolve. Italy must urgently prioritise quality of its health care services alongside fiscal sustainability. Regional differences must be lessened, in part by giving central authorities a greater role in supporting regional monitoring of local performance. Proactive, coordinated care for people with complex needs must be delivered by a strengthened primary care sector. Fundamental to each of these steps will be ensuring that the knowledge and skills of the health care workforce are best matched to needs.

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Quality strategies in the Italian health care system

There are a range of laws and regulations in Italy that in various ways address quality of care to ensure effective, safe and patient-centered health service delivery. The devolution of power to regions has, however, resulted in a range of quality initiatives at regional level: some regions have very well developed approaches towards the systematic measurement and management of quality improvement while other regions still have rather weak quality governance models. The challenge for Italy will be to achieve a more comprehensive and uniform approach towards quality monitoring and improvement throughout the country. Some steps have already been taken in this direction, but more could be done to guide all regions towards the robust quality improvement for the health system. A stronger central role for the Ministry of Health and/or its agencies (such as AGENAS), the development of more robust inspection functions to monitor minimum levels of care and patient safety standards are key priorities. Efforts are also needed to develop a stronger information infrastructure which, used appropriately, can contribute to quality improvement efforts. Data should be used more effectively as part of ongoing initiatives around performance monitoring of both health providers and health care facilities. A strategic focus on increasing patient involvement is also needed to steer more systematic quality improvement. 1

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