Veneto Health System Zeeland Denmark EU Office Brussels, 11th May 2009 Daniela Negri

Veneto Health System

Zeeland Denmark EU Office

Brussels, 11th May 2009

Daniela Negri

11th May 2009 2

SummarySummary

• Part 1– National and Regional Health System– Regional Health Care Resources

• Part 2– Objective and Priorities 2007-2009– Waiting List

• Part 3– Partnership and networks– EU Projects– Contacts

11th May 2009 3

Part 1

– National and Regional Health Systems– Regional Health Care Resources

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Veneto RegionVeneto Region

•18.390 km 2

•4.8 million inhabitants

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Health devolution: Health devolution: From 2001 new competences From 2001 new competences

for the regionsfor the regions

Italian Constitution: New Art.117:

All domains concerning human health pertain to the legislative function of the Regions.

Regions are responsible to plan and provide health and social services.

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Italian Health Care SystemItalian Health Care System• Universal coverage, free of charge;• Funded through general taxation;• 3 level:- National:

» General objectives & fundamental principles» LEA - Essential levels of care provision» Regulatory function for drugs & medical equipment

- Regional: » Management & organisation: target orientation,

delegating management to Local Health Authorities (LHA) and structures;

» Coordination and control» Financially accountable» Legislative & administrative functions Planning

- Local: » Management &delivery

11th May 2009 7

Veneto Region Social and Health Care System Veneto Region Social and Health Care System Organization ChartOrganization Chart

Minister for HealthPolicies

Minister for Social Policies

Secretary for Social and Health Policies

Dep. Of Prevention

Dep. Of HealthCare

Planning

Dep. Of EconomicResources

Dep. forHospitals

Dep. of Social

Services

11th May 2009 8

Veneto Health Care ModelVeneto Health Care Model

1. Multi-tiered structure in the territory2. Structural integration between local community

and hospital3. Integration between social and health care4. Delegating management to local health

authorities (LHA)5. Fostering coordination between LHA, NGOs,

public authorities

11th May 2009 9

Veneto Region Health System:Veneto Region Health System:Numbers and FiguresNumbers and Figures

• 21 territorial LHAs (managing 60 hospitals)

• 2 public hospital trusts• 1076 specialist health care service providers • 1307 pharmacies• 3600 general practicioners• 250 residential home for the elderly• hospital beds in the public system are 19,429

(85.85% of the regional total) and 3,470 private hospital beds (15,15%)

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The Veneto RegionThe Veneto Regionis divided intois divided into

21 Local Health Authorities 21 Local Health Authorities (LHAs)(LHAs)

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Financing - I

• Regional Health System Based on general taxation.

• The Government together with the Regions negotiates annual quota for funding the regional systems.

• LHA global budget - weighted capitation mechanism- adjusted according to the historical spending- additional compensation is given for cross-boundary inter-regional flows;

• Hospital providers: fees for services ( DRG) ;• GPs capitation.

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Financing - II

Percentage of total expenditure on health

according to source of revenue (2004)

TAX76%

OPP19%

VHI2%

OTHER3%

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Financing - III

Trends in health care expenditure in Italy

1988-2004 (billion € at 2000 GDP prices)

0

10

20

30

40

50

60

70

80

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Public Private

Trends in health care expenditure in Italy, 1988-2004

Indicators 1988 1990 1995 2000 2003 2004

Total health expenditure in per capita US$ PPP

1 195 1 391 1 535 2 049 2 266 2 424

Total health expenditure as a percentage of GDP

7.7 7.9 7.3 8.1 8.4 8.7

Public expenditure on health as a percentage of

total expenditure77.6 79.1 71.9 72.0 73.7 75.1

Private expenditure on health as a percentage of

total expenditure22.4 20.9 28.1 26.5 24.9 23.6

11th May 2009 14

Regional Investment in Health & Social Services Regional Investment in Health & Social Services

20082008 • Regional budget allocation for Healthcare: € 7.2 Billion

• Regional investment allocated to the Social Sector:

For non self-sufficient,

mainly elderly citizens and

other vulnerable population

groupsTo provide services to

drug addicts

For financing other programmes:

home care for the elderly;

support to families with chronically-ill

dependent;

telehelp for caregivers;

services for disabled people

€€820 M820 M

11th May 2009 15

Veneto Region – Health ExpenditureVeneto Region – Health Expenditure

HC GOODS9%

NON HC RELATED GOODS1%

REGIONAL HC SERVICES12%

EXTRA REGIONAL HC SERVICES

2%

PRIVATE SECTOR SERVICES31%

PUBLIC SECTOR SERVICES1%

PURCHASES OF NON HC RELATED SERVICES

7%

PERSONNEL COSTS32%

EXTRAORD.BURDENS0%AMORTIZATIONS AND

DEVALUATIONS2%

FINANCIAL BURDENS0%

OTHER COSTS3%

11th May 2009 16

Part 2

– Objective and Priorities 2007-2009– Waiting List

11th May 2009 17

Health and Social Affairs Plan Health and Social Affairs Plan 2007-2009 (1)2007-2009 (1)

Strategic Objectives:

A. Better Implementation of Essential Level of Care Provision• Reducing Waiting Lists• Reduction of costs maintaining high quality

B. Increasing Prevention and Health Promotion:• Healthy life styles promotion• Increasing prevention• Promotion to a correct use of medical drugs• Promotion of policy addressed to family, adolescent, infants and

young people• Health and integration of immigrant people

C. Increasing Quality

11th May 2009 18

Health and Social Affairs Plan Health and Social Affairs Plan 2007-2009 (2)2007-2009 (2)

D. Renewing Health Care System• Better integration of providers and hospitals• Interoperability among health systems, including emergencies

units• Better collaboration between universities and health providers for

training• Improving utilization of smart-cards

E. Improving Research and Innovation:• Increase biomedical and health research;• Increasing use of technology (HTA, diagnosis, …)• Use of innovative managerial and organization model

F. Citizenship Participation:• Freedom in choosing health care providers• Involvement of Third Sector• Better communication

11th May 2009 19

Economic Pressures on Veneto Economic Pressures on Veneto Regional Health and Social SystemRegional Health and Social System

• Impact of Technologies:– Rising costs due to technological innovation

• Demographic and Social Changes:– Ageing population– Patient mobility: tourists, immigrants, long

term residents

• Lack of health professional (mainly paediatricians and nurses)– Waiting Lists

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Tackling a challenge:Tackling a challenge:Reducing waiting lists…Reducing waiting lists…

National Plan for Reduction of Waiting Lists 2006-2008

Oblige Regional Authorities to:• Define a Regional Work Plan to reduce waiting lists• Define the maximum number of waiting days for each disease

category• Define financial consequences for unfulfilling Regional Authorities

Regional Law DGRV 300/2007 and

“Intramoenia” experience

Local Health Authorities Implementation

11th May 2009 21

Reducing Waiting Lists… (2)Reducing Waiting Lists… (2)

Regional Law DGRV 300/2007Regional Law DGRV 300/2007

4 main objectives:

1. Definition on each prescription the specialistic visit category and maximum of waiting days allowed per category

2. Definition of 2007 targets

3. Implementation of a monitoring system

4. Evaluation of Local Health Authority Directors on the

basis of the Waiting List Plan’s results

11th May 2009 22


Hospital Admission

Category DescriptionMaximum

Waiting days

A disease tending to become emergency 30 days

Bdisease with intense pain or serious disability, not tending to become emergency

60 days

Cdisease with slight pain, without relevant disability, not tending to become serious

180 days

D disease without pain and disability 12 months

DGRV 300/2007 - DGRV 300/2007 - Objective 1 : :Definition on each prescription the specialistic visit category and maximum waiting days allowed per category

11th May 2009 23


Examination

Category Category Description Service Maximum Waiting days

Adisease tending to become emergency

General examination 10 days

Specialistic examination 10 days

B

disease with intense pain or serious disability, not tending to become emergency



C

disease with slight pain, without relevant disability, not tending to become serious



Ddisease without pain and disability



DGRV 300/2007 - DGRV 300/2007 - Objective 1 : :Definition on each prescription the specialistic visit category and maximum waiting days allowed per category

11th May 2009 24


Category 31/12/2007 31/12/2008

Physician Office

service

A 80% 90%

B 70% 80%

C 90% 100%

D

Hospital Admission

A 100%

B 50% 90%

C 50% 80%

D 70%

Oncology 100% 100%

DGRV 300/2007 - DGRV 300/2007 - Objective 2: : Definition of 2007 targets

11th May 2009 25

Reducing Waiting Reducing Waiting Lists… (6)Lists… (6)

“It’s time to care”

Advertising campaign to inform citizens on their rights on waiting time for care

11th May 2009 26


Intramoenia experience:

• Possibility for patients to be cared in a public structure in a private visit by a private specialistic physician;

• Public Service Fee < Intramoenia Fee > Private Fee;

• Guarantees citizens’ freedom of choice;

• Contributes to reduce waiting lists

11th May 2009 27

Part 3

– Partnership and networks– EU Projects– Contacts

11th May 2009 28

Representative Offices of the Veneto RegionRepresentative Offices of the Veneto Region

VeniceVenice

11th May 2009 29

International Health and Social International Health and Social Affair Office activities in VeniceAffair Office activities in Venice

• Development of joint programmes with the WHO• Health care emergency programmes• Interregional coordination with the Italian

Ministry of Health, the Foreign Affairs Ministry and the Italian Red Cross

• Organisation of study visits of regional delegations

• Organisation of workshops• Twinning initiatives with the regions of candidate

member states

11th May 2009 30

Brussels OfficeBrussels Office

• Regional participation in EU health care policy development

• Monitoring of EU public health activities and initiatives

• EU funded projects

• Training and information activities on EU topics

11th May 2009 31

ParticipationParticipation in international in international networksnetworks

• Regions for Health Network

• Alpe-Adria Working Community

• European Observatory on Health Systems and Policies

• ERRIN

• EUREGHA

WHO REGIONS FOR HEALTH NETWORKWHO REGIONS FOR HEALTH NETWORK

http://www.euro.who.int/RHN

•Flemish Community•Varna•Northern Bohemia, Northern Moravia•Lower Saxony, North Rhine- Westphalia•Bács Kiskun, Györ Monson Sopron Szabolcs-Szatmár•Northern Region•Emilia-Romagna, Veneto, Sicily•Kaunas•Rogaland•Silesia•Madeira•Vologda•Catalonia, Extramadura, Valencia•Västra Götaland, Östergötland•Ticino•North West England, Wales

Belgium Bulgaria Czech Rep Germany Hungary IsraelItaly Lithuania Norway Poland Portugal

Russia Spain Sweden SwitzerlandUnited Kingdom

11th May 2009 33

Alpe Adria Working CommunityAlpe Adria Working Community

11th May 2009 34

The European Observatory on The European Observatory on Health Systems and Policies Health Systems and Policies

• Partnership:– International Organisation: the WHO Regional Office for Europe,

the European Investment Bank, the Open Society Institute, the World Bank,

– National Governments: Belgium, Finland, Greece, Norway, Spain and Sweden,

– Regional Government: Veneto Region– Research Institute: the London School of Economics and

Political Science (LSE), the London School of Hygiene & Tropical Medicine (LSHTM), CRP-Santé Luxembourg

• Aim: support and promote evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe.

11th May 2009 35

ERRIN ERRIN

• Collect and give pre-information on FP7, providing ERRIN network with a technical background in FP7;

• Discuss and circulate methods, tools and good experiences on how regions tend to identify and develop regional development strategies;

• Develop proposals to open consultations;• Networking.

11th May 2009 36

EUREGHAEUREGHA Aims to:Aims to:• Share information and experiences;• Forum for EU institutions and local / regional

(health) authorities;• Raise awareness of local / regional dimension

and enhance local / regional influence on EU health initiatives;

• Provide expert knowledge and added value to EU institutions;

• Cooperate with other health networks and NGOs.

11th May 2009 37

European Health ProjectsEuropean Health Projects

managed by Veneto Regionmanaged by Veneto Region

• 20 running project

• 2 in negotiation phase (Call PH 2008)

• 2 in evaluation (Call FP7 2008)

11th May 2009 38

European Health Projects European Health Projects The BudgetThe Budget

Progetti in gestione

Total Budgetin €

Cofinanc. CETo RV in €

Cofinanc. RVin €

€EC/BudgetProject

RGV

Health 13 50.949.137€ 2.183.102€ 3.487.780€ 38%

Social Affairs

6 1.577.823€ 139.205€ 155.081€ 47%

3.300.000€ of contribution in kind

11th May 2009 39

EU Projects - HealthEU Projects - Health Titolo Oggetto Programma Leader Ref.

RGVBudget totale in €

Cofinanz. CE alla RV in €

Cofinanz RV in €

1 DETERMINE

Costituire un consorzio europeo per l’azione sul controllo dei determinanti socio-economici della salute

Salute Pubblica Call 2006

Istituto nazionale di salute pubblica della Repubblica Ceca

SRSSI 1.899.000 8.476 12.000

2 SIALON

Lotta all'HIV attraverso un sondaggio tramite utilizzo di kit sperimentali

Salute Pubblica 2007

Regione Veneto

CRRPS - ULSS 20 Verona

714.451 152.715 126.720

3CHI-CY-TOBACCO

Costruire una rete di partner europei che collaboreranno insieme per affrontare le questioni legate al controllo del tabagismo.


Liverpool Primary Care Trust (UK)

Azienda USL 19 Adria, Finessi

699.414 28.473 63.890

11th May 2009 40

EU Projects - HealthEU Projects - Health Titolo Oggetto Program

maLeader Ref.



Cofinanz RV in €

4HEALTH OPTIMUM II

Definire uno standard organizzativo/funzionaleper l’erogazione di prestazioni sanitarie a distanza e sviluppare delle applicazioni di telemedicina

eTen – call 2006

Regione Veneto

USSL 9 – Treviso Ufficio Bruxelles: Ronfini e Motta

19.403.589 1.615.000 2.566.000

5“HEALTHY REGIONS

Promuovere investimenti pubblici in campo sanitario nelle regioni attraverso una migliore identificazione, governance e uso strategico delle competenze sanitarie regionali.


South Denmark European Office

CRRPS* - USSL 20 Verona

1.127.125 72.062,99 67.268

6 NETC@RDS

Estensione della versione sperimentale della Tessera elettronica Europea Assicurazione Malattie

eTen – call 2006

Sesam Vitale EIG (Francia)

USSL 13 Dolo Mirano

15.334.380 102.986 461.823

11th May 2009 41

EU Projects - HealthEU Projects - Health Titolo Oggetto Progra

mmaLeader Ref



Cofinanz RV in €

7TEN 4 HEALTH

Testare un servizio di interoperabilità delle carte elettroniche della salute

eTen – call 2006

AOK Rheinland Hamburg

USSL 10 Veneto Orientale e ULSS 13 Dolo Mirano

1.900.018 18.522 18.523

8 SEID

Produrre un catalogo trasnazionale delle possibilità di intervento su prevenzione, cura, terapia e l’inclusione sociale tra i giovani per


FICT Federazione Italiana Comunità Terapeutiche Roma

Ufficio prevenzione delle Devianze

548.227 34.500 36.714

9 VENICE

Armonizzare i dati riguardanti le infezioni nosocomiali e la resistenza agli antibiotici in Europa

Salute Pubblica 2004

Istituto Superiore di Sanità (Italia)

989.900 51.924 60.200

11th May 2009 42

Eu Projects - HealthEu Projects - Health Titolo Oggetto Progr. Leader REF

RGVTot. Budget

Cof CE a RGV

Cof RGV

10EUnetHTA

Rete europea per la valutazione dell’impatto delle tecnologie sulla salute

Sanità Pubblica 2005

DACETHA

Dir.Piani Programmi Socio-Sanitari

3.233.858 17.490 25.681

Euregio II

Sviluppo di strategie per l'offerta di servizi sanitari trasfrontalieri


North Rhine Westfalia

0 0

11INFORM

Lotta all'obesità nei bambini e adolescenti


Ospedale di Villach

CRRPS 2.181.386 28.851 32.160

13

PROMETHEUS

Health Professional Mobility in the European Union Study

7PQ – Health – Call 09/07

EHMA 2.917.789 52.100 16.800

11th May 2009 43

EU Projects – Social AffairsEU Projects – Social Affairs Titolo Oggetto Programma Leader Ref RGV Budget

totaleCOF CE COF RVE

1 ESN - European Social network

Individuazione di nuovi indicatori europei per politiche sociali contro la povertà e l'esclusione sociale

Azione "Finanziamento reti attive nella lotta contro la povertà e l'esclusione sociale - DG Occupazione & Affari Sociali

European Social network (UK)

DirezionUe Servizi Socilai

270.585,00 12.000,00 4.500,00

2 DEFT Elaborazione di un modello comune di intervento per operatori del settore

Leonardo da Vinci - Direzione Generale "Istruzione e Cultura"

Comune di vasteras (Svezia) (N.B.: partenariato ENSA)

Osservatorio regionale per l'Infanzia e l'adolescenza - ULSS 3

399.405,00 58.500,00 43.875,00

3 PERCENTAGE

Creazione di uno strumento formativo informatico per formazione degli operatori sanitari e sociali

Leonardo da Vinci - Direzione Generale "Istruzione e Cultura"

Contea del Surrey (UK) (N.B.: partenariato ENSA)

Direzione Servizio Anziani e Disabilità - ULSS Rovigo

414.000,00 30.494,00 10.165,00

4 EHLE Creazione di un kit formativo pergli operatori impegnati nell’educazione alla salute degli anziani”

Grundtvig Regione del Veneto

Comune di Padova + ULSS16

343.256,00 28.731,00 73.332,00

OPNE DOOR

Interventi a favore di giovani a rischio di esclusione nell'aree metropolitane

Youth in Action DG "Istruzione e Cultura"

Regione veneto

Osservatorio Regionale Infanzia Adolescenti Giovani e Famiglie

150576,57 9480,12 23209,19

6 DESIGN FOR ALL

Corsi di formazioni rivolti ad architetti e autorità locali, nell’ambito della tematica dell’accessibilità.

Leonardo da Vinci Partnerships

Conseil général du Val-de-Marne

Direzione regionale Servizi Sociali

11th May 2009 44

Avenue de Tervueren, 671040 Brussels

Tel +32 2 7437025 – 22 - 20Fax +32 2 7437019

[email protected]

[email protected]

Palazzo Cavalli Franchetti San Marco, 2847 - 30124 VeneziaTel. 041 2791426-7Fax. 041 2791366

[email protected]

[email protected]

International Health and Social Affairs OfficeInternational Health and Social Affairs Office

11th May 2009 45

Thanks For Your Attention

Documents

Veneto Health System Zeeland Denmark EU Office Brussels, 11th May 2009 Daniela Negri