The growth and composition of primary and community-based care services. Metrics and evidence from the Italian National Health Service.


Change log
Authors
Longo, Francesco 
Salvatore, Domenico 
Tasselli, Stefano 
Abstract

BACKGROUND: Over the past few decades, in OECD countries there has been a general growing trend in the prevalence of out-of-hospital healthcare services, but there is a general lack of data on the use of these services. METHODS: We defined a list of 303 indicators related to primary and community healthcare services in collaboration with 13 Italian Local Health Authorities (LHAs). Then, for each LHA, we collected and analyzed these indicators for two different years (2003 and 2007). RESULTS: Out-of-hospital care absorbs 56% of all costs in our sample of LHAs. Expenditure on outpatients' visits to specialists and on diagnostic examinations accounts for 13% of the costs, while spending on primary care (including prevention and public health) accounts for 9%, and for intermediate structures (including those related to rehabilitation, elderly people, disabled people, and mental health) the figure is 11%. Different Italian LHAs have made different strategic choices with respect to primary and community-based care (PCC). CONCLUSIONS: Two distinct strategic orientations in the adoption of PCC services by LHAs has emerged from our study. The first has been an investment mainly in ambulatory and home-based primary care services in order to increase the number of low-complexity settings. A second strategy has prioritized the allocation of resources to intermediate inpatient structures for specific types of patients, namely elderly and disabled people, post-acute patients in need of rehabilitation and long-term care, and patients in hospices.

Description

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.

Keywords
Community Health Services, Health Care Reform, Humans, Italy, National Health Programs, Primary Health Care, Quality Indicators, Health Care
Journal Title
BMC Health Serv Res
Conference Name
Journal ISSN
1472-6963
1472-6963
Volume Title
Publisher
Springer Science and Business Media LLC