Differentiated autonomy, what are the future effects in healthcare? To date, Italy is divided in two, with 11 Regions promoted, 6 postponed, 4 rejected

55 percent of Italians live in regions with satisfactory results for health protectionbut for 45 percent this is not the case. Promoted with good “grades” the Regions of Veneto, Piedmont, the autonomous Province of Bolzano and Tuscany – where over 13.3 million inhabitants live -; promoted with the «enough» Friuli Venezia Giulia, the autonomous province of Trento, Emilia Romagna, Liguria, Valle d’Aosta, Marche and Lombardy (19.3 million people live in these regions); «postpone» Sardinia, Campania, Lazio, Umbria, Abruzzo and Puglia (overall 18.9 million inhabitants); «fail»: Sicily, Molise, Basilicata and Calabria, regions in which approximately 7.5 million people live. It is a photograph of a country divided in two, with the usual gap between North and South, the one taken in the 2024 Report «Opportunities for health protection: the Performance regional» of Crea Sanità – Center for economic research applied in healthcare. The study, presented today in Rome, was conducted by around a hundred experts, based on a series of indicators.
This year, a “dynamic” monitoring system was also created future effects of differentiated autonomy in healthcarebased on a subgroup of performance indicators selected by panel.

The study and the indicators

The Crea Sanità study, which makes use of the work of researchers and university professors in various fields – from economics to law, from epidemiology to medical statistics and biomedical engineering – was conducted by over one hundred experts grouped in a panel divided into five groups: institutions, management corporate, healthcare professions, users, medical industry.
The a.s. were evaluatedhealth, social, economic, innovation and equity aspects of carebased on 20 indicators.
In particular:
– for theappropriateness the indicators analyzed were the percentage of accesses to Emergency room on weekdays from 8 am to 8 pm of adults with a white/green discharge code, the rate of elderly people treated in Adi-integrated home care; the percentage of membership of the prevention vaccination in children and in the elderly and at screening, the rate of hospitalization (avoidable) for chronic diseases;
– for theequity the share of were analysed passive mobility effective for low and medium complexity DRGs (services and interventions that, at least in theory, the Region must guarantee, and for which, therefore, it would not be necessary to move), the percentage of specialist services -visits and exams – with priority «B» carried out on time or within 10 days, the share of people who waiver of health benefits (for economic reasons, long waiting lists, inconvenient times, etc.);
– for the outcomes the indicators analyzed were the index of mental health, the percentage of the population that adopts correct lifestylesmortality for heart attack acute 30 days after hospitalization, the life expectancy of the over 65 years old without functional limitations;
– for theinnovation the percentage of implementation of the was taken into account electronic health recordof the implementation index of the Oncology network and the share of interventions executed with minimally invasive techniques;
– for the size economic-financial the standardized total health expenditure per capita, the incidence of the disease were analysed expenditure on private healthcare consumption of families on total consumption, public health spending per capita and the gap compared to the average in the European Union;
– for the dimension social the rate was taken into account over 75 year olds who are not self-sufficient in residential socio-health treatmentof the percentage of fragile or at-risk people (elderly and poor) who receive interventions for social integration and the rate of people elderly and/or with disabilities that they receive integrated home care with health services.

The votes”

Made 100% the maximum achievable result, the evaluation of performance regional, in terms of health protection opportunities offered to their citizens, fluctuates from a maximum of 60% to a minimum of 26%. Based on these criteria, the result improve he got it Veneto and the worse there Calabria. The result of this analysis gives the real measure of the organisation’s effectiveness and gods outcomes of social and health careand, according to the authors of the study, it will also allow monitor the effects of the application of differentiated autonomy from the North to the South of the country.
Made 100% the maximum achievable result, the evaluation of performance regional, in terms of health protection opportunities offered to their citizens, fluctuates from a maximum of 60 percent to a minimum of 26%. Based on these criteria, the result improve he got it Veneto and the worse there Calabria (the results on the map).

The North-South divide remains, but the distances are decreasing

But there is also one good news: even if the gap between northern and southern regions remains, however in recent years it has distance reduced in terms of health protection opportunities between North and SouthIn the last five years, the Crea Sanità Report reports, there has been a 46% improvement from the performancethat has interested all geographical areas and, to a greater extent, the Southern regions (+75.9% on average), followed by the Regions of the North-East (+44.9%), those of the North-West (+40.9%) and the Center (+37.4%).
Although there is room for action to reach 100% of the value of the performance index, the Report explains, «it does not appear that the Regions with performance best are able to record significant progress: probably indicating the existence of structural limits in the current structure of the healthcare system».

Differentiated autonomy, four groups of Regions compared

Create Healthcare has developed the methodology for monitor the effects of differentiated autonomy in healthcare ( HERE are the news of the Law definitively approved on 19 June) when it will be granted to one or more Regions, based on the new Law. In order to test the implementation of the method, the dynamics on ten indicators chosen by panel of experts in groups of Regions:
-the group of Autonomous Provinces/Regions or those with special statute (Sicily, Sardinia, Valle d’Aosta, Friuli Venezia Giulia and Trentino Alto Adige with Trento and Bolzano) towards others;
– The group of Regions in Repayment plan (Abruzzo, Calabria, Campania, Lazio, Molise, Puglia, Sicily) towards the other Regions;
– the group of Regions that have requested differentiated autonomy in 2017 (Lombardy, Veneto, Emilia Romagna) towards the others.
THE results were aggregated in areas «cumulative» of improvement and worsening And synthesizedfor each group of Regions proposed for comparison, in a numeric index: L'”Weighted synthetic index». The value «0» indicates an overall compensation between regional improvements and worseningThe value «1» a improvement for all the Group’s Regions and the value «-1» one of them worsening.
According to the authors of the Report, overall, in the period 2017-2022 the dynamics in Provinces/Autonomous Regions or with special statute was (slightly) worse compared to the group of the others (the weighted synthetic index is 0.38 and 0.40 for the others).
In the second comparison
In the second comparison, the Regions in Repayment plan record an Index equal to 0.44, compared to 0.37 for the others, therefore the dynamics, overall, is improve than in the group of others.
In the third comparison, the Regions that requested differentiated autonomy (Emilia Romagna, Lombardy and Veneto) recorded a weighted synthetic index equal to 0.36 compared to 0.40 for the others, therefore with performance slightly worse compared to the group of other Regions.

According to the Crea Sanità researchers, the monitoring and evaluation system, while waiting for the terms of access to differentiated autonomy to be clarified, can potentially represent a support for social and health planningproviding indications both with respect to the effects and impact of any institutional changes, and on any areas of action, at the different levels of governance: national, regional, local

The Medical Association: measures to reduce inequalities

The law on differentiated autonomy (definitively approved on 19 June by the Chamber of Deputies but not yet published) predicts that also for the health protection greater autonomy may be requested by the Regions.
Hence the warning from Fnomceo, the National Federation of Orders of Surgeons and Dentists, according to which it is necessary to provide measures and interventions to ensure that the health inequalitiesThat with differentiated autonomy they could expandthey are filled or avoided. As? «The way forward – says the Fnomceo president, Filippo Anelli – is to give the Government the possibility of intervening to reduce inequalities through a strengthening of the Ministry of Healthso that we can intervene where those Regions or territories present serious differences in terms of health protection for their citizens”. But we also need to “guarantee more resources for healthcare, protect above all the regions and territories most exposed to inequalities. We believe – reiterates Doctor Anelli – that here, once again, we need to intervene supporting professionals, because inequalities in healthcare are resolved through skills.”