It is called “good mobility” and corresponds to the need to access assistance from highly specialized centers. “It is not a sign of inefficiency,” explains Andrea Urbani, director of health planning at the Ministry of Health
When we talk about interregional healthcare mobility, it is usually done with a negative meaning, as a sign of a local disservice that forces patients to move to another region to receive treatment. «But not all migration is a symptom of the inefficiency of the care system of a territory. On the contrary”. To clarify the issue, which has often ended up at the center of controversy by politics and public opinion, is Andrea Urbani, Director General of Health Planning of the Ministry of Health. Within the universe of extra-regional care, one can first of all identify a component of “fake” mobility. “This is the case of citizens who, despite being resident in one region, benefit from health services in another territory because they have their domicile there for work or study. This fake mobility also includes that of those who are assisted at the vacation spot. As well as the “border mobility“, Of a physiological type, determined by the design of the administrative borders of our country and by the regional structure of the National Health Service, which does not involve any inconvenience for the citizen, who simply chooses the health facility geographically closest to his home, even if located in a neighboring region “.
What, then, is true mobility?
«Mobility in the strict sense includes“ positive ”and“ pathological ”flows. The latter refer to the request for services outside the region of low or medium care complexity, i.e. for routine health problems, which do not require significant investments of resources and professionals, and are caused by the lack of services in certain territories or by long waiting lists. . This type of mobility can fuel the interest in a coming and going of patients from the South to the North and generates inequity, since only patients with medium-high income tend to be able to bear the costs of travel. Citizens are willing to travel many kilometers to face important treatments, with the expectation of a better outcome than what would be obtained by being treated in their region. It is a phenomenon that must be addressed, carefully evaluating what escape services are and investing in the regeneration of health services in the territories from which one is fleeing, in order to reduce geographical disparities and guarantee equal access to care for all citizens. Net of border mobility, we are talking about about one billion euros of passive mobility (which expresses the index of flight from the region, ed) which can be recovered in the central-southern regions through the strengthening of local health ”.
When does it make sense to go to another region for treatment?
«The“ good ”mobility, to be encouraged, is that which concerns some highly complex and highly complex services, for rare pathologies or whose caseloads are limited. It responds to the golden rule in health, according to which if the incidence of cases is low, the guarantee of very high levels of clinical standards is considered prevalent compared to the proximity of the service through the creation of centers of excellence of regional or supra-regional value, in relation to the catchment area of the disease and to the size of the population of the individual region, where to concentrate patients, in order to develop volumes of activities that keep the health team “trained” and, consequently, obtain better health outcomes. Even in the face of any inconvenience related to travel. This is the “hub and spoke” organizational model, envisaged by ministerial decree 70 of 2015, which identifies centers of reference, the hubs, which manage the most complex patients, and peripheral facilities, the spokes, to which less demanding ones are sent. With such an organization, designed to ensure maximum safety and quality of care, there will be regions with one or more centers and others, less populous and with a lower number of cases, which will not necessarily have none “.
A few examples?
“If on the one hand it is necessary to guarantee the timeliness of intervention at a territorial level for time-dependent pathologies, on the other there are networks of high specialty on a regional or supra-regional basis, for example for highly complex pediatric interventions in the field of cardiac surgery, neurosurgery , nephrology and urology, for severe burns, organ transplants, some forms of rarer pathologies, such as pancreatic cancer, all highly specialized surgery, from the thoracic one for the removal of tumors to the cardiac one. The mobility that derives from this organizational model, then, cannot always be considered a negative effect, but rather a signal of appropriate use of the health supply network in the country. Pediatric cardiac surgery services provided to patients from outside the region represent 34 per cent at the national level and, even if it is a question of mobility, it is clear that “positive” mobility must be considered. As well as that for pediatric nephrology, at 25 per cent, pediatric neurosurgery, at 42, or pediatric urology, at 26. These are mobility data that clearly show the effective functioning of the network of supra-regional reference centers “.
Who is responsible for drawing up a national program to correct “pathological” flows?
“The budget law for 2021 instructs the Lea Committee (the body that must verify the provision of essential levels of health care throughout the national territory), of which in addition to the representatives of the ministries of Health and the Economy even those of the Regions. It will be one of the main challenges that the National Health Service will have to take seriously, and methodically, in the coming months. The causes of avoidable mobility, that is linked to the lack of quality health services and the long waiting lists in the individual territories, will have to be analyzed and compared with the volumes of activity and the results of the hospitals. This will make it possible to develop targeted investment programs to strengthen regional networks, also with the involvement of the main centers of attraction for health tourism, which will be able to transfer skills and management models for the sick ».
August 26, 2021 (change August 26, 2021 | 15:10)