Treat yourself away from home, who does it and why –

by time news

Before the epidemic, almost 800,000 Italians chose to move to hospitals outside their region of residence. A choice that is only necessary in some cases, because often the same therapies can be received close to home, even if many do not know it.

Almost 800,000 Italians, the year before the Covid pandemic broke out, traveled in search of a recovery in health facilities outside the region of residence. Some have preferred to turn to the services of the neighboring region because they are closer to their homes, while others have crossed two or more borders, grinding hundreds of kilometers between ups and downs for diagnosis, hospitalization and check-ups. Anyone free to choose where to heal. The right to health not conditioned by the place of birth, domicile or residence. The point is another: to identify the real reasons that push patients to seek assistance away from home. The record levels of interregional health mobility achieved in the pre-Covid period therefore deserve attention.

The analysis of the ministry

In the decade 2008-2018, according to an analysis published by the National Agency for Regional Health Services (Agenas), whose author was the engineer Francesco Bortolan, the economic volume of all health services provided outside the region (hospitalizations, visits, spa treatments , medicines, ambulance transport) went from 3.6 billion to 4.3 billion, an increase of 19 percent. Each year the region that provides health care comes refunded from that of residence of the citizen, who is responsible for paying for travel by car, train or plane and any accommodation. The tendency of citizens to take care of themselves outside the regional border is growing everywhere, both in the North and in the South, explains Domenico Mantoan, general manager of Agenas.

Regional differences

However, the analysis points out, this does not mean that all the Regions are able to achieve an adequate balance between the flight of residents and the ability to attract patients away from home. The Regions that most of all have been able to balance the share of external demand for services with that of leak beyond its own border of residents, and which consequently boast the best balance of mobility between credits and debts accrued to other regional health services are, in order: Lombardy (with a balance that went from pi 449 million euros to pi 698 million since 2008 to 2018), Emilia Romagna (from pi 335 million to pi 338 million), Tuscany (from pi 103 million to pi 143 million) and Veneto (from pi 99 million to pi 126 million). The most indebted ones are: Campania (from minus 301 million to minus 320 million), Calabria (from minus 232 million to minus 281 million), Lazio (from minus 93 to minus 216 million; in this case the figure net of mobility related to Bambino Ges hospital, which is extraterritorial), Sicily (from minus 202 million to minus 213 million) and Puglia (from minus 175 million to minus 192 million). Basically, what does this mean? That the Regions with a positive balance are increasingly attractive, while those with a negative balance increasingly suffer the migration towards the outside of their residents, underlines Mantoan. THE Drg (i.e. i homogeneous groupings of diagnoses with which hospital admissions are classified and the relative rates attributed) of the orthopedic type are the masters. Interventions for the replacement of major joints (hip, knee, shoulder and ankle prostheses) represent the most requested services in extra-regional structures by patients from both the Center-South and the North.

The most requested services

The first five DRGs in the regions most indebted for escape include operations for the stabilization of the spine, operations on heart valves by catheter, those on the uterus, tubes and ovaries (not for malignant tumors), on the foot, transplants bone marrow, liver and intestine. Private facilities accredited with the National Health Service (NHS) in 2019 recorded on average half the value of extra-regional hospitalizations (1.6 billion euros). With peaks of 86 percent in Molise, 72 percent in Lombardy, 71 percent in Puglia and 65 percent in Lazio. On the contrary, the attraction by public hospitals, looking at the northernmost part of the country, has generated an income equivalent or almost to the private one in Veneto, Emilia Romagna, Piedmont and the province of Trento. It is clearly higher in the province of Bolzano (97 per cent), in Liguria (88), Valle d’Aosta (82), Friuli Venezia Giulia (75) and Tuscany (67). Border mobility can be implemented and facilitated by accredited private individuals, who have a ceiling on the cost of care for residents but have no spending limits on those provided to citizens outside the region, comments Mantoan. Highly complex care services, from cardiac surgery and neurosurgery to transplants, from interventions on the kidney for cancer to those on heart valves, pancreas and liver, etc., are the only ones that should be left to hospitals (those of low and medium complexity should be provided without ordinary hospitalization, in day hospital, in intermediate structures, in outpatient clinics on the territory or at home) and concentrated in centers with an adequate case history in terms of volumes to ensure quality and safety, weigh for 1.4 billion euros, equal to approximately 44 per cent of all the value of mobile admissions (3.2 billion). And just over half (53 percent) was allocated to the hospitalization of patients arriving from distant regions. Citizens must be guaranteed the freedom to choose where to take care of themselves, Mantoan still remembers. If they do it for less important pathologies, which do not require a high level of specialty, it is necessary to ask about the health needs of the sick who migrate elsewhere and facilitate their care in the area.

Inappropriate hospital stays

Then there are hospitalizations that continue to be carried out despite being potentially inappropriate and therefore avoidable (they are part of a list of 108 DRGs to be treated in a care setting other than ordinary hospitalization, identified with the State-Regions Agreement of 3 December 2009), such as those for knee surgery without a main diagnosis of infection, for inguinal and femoral hernia, salivary glands, non-malignant breast diseases, minor skin diseases, kidney dialysis, radiotherapy. The Agenas document also calculates the need for hospitalizations for all surgeries within the single region (the overall one in Italy of 3.6 million services) and the relative capacity to satisfy those who need highly specialized technologies and skills. Result: six regions are fully autonomous (Lombardy, Emilia Romagna, Veneto, Tuscany, Piedmont and Molise), four have strong management criticisms (Calabria, Sardinia, Sicily and Campania), the rest of the country getting by with more or less difficulty . The intention of this analysis concludes the director of Agenas to give the governors a key to understanding the health flows both in and out of their region, to understand where, how and if to intervene to strengthen or reorient the network of services in the area. If the Regions ask us, the Agency will be able to provide support in the drafting of the new programming.

November 20, 2021 (change November 20, 2021 | 18:19)

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