1. Improving the governance of the health system:
the example of Veneto Region
8 June 2017, 10:00 – 12:30, room P7C050, European Parliament, Brussels
Domenico Mantoan
General Director,
Health and Social Care Area, Veneto Region

2. Veneto Region Veneto Italia VENETO Chronic 65% of > 65 years
Population
4.9 million
59.8 million
Gdp
30,500 euro
26,700 euro
Life expectancy at birth
M: 80.7
F: 85.4
M 80.1
F: 84.7
Unemployment
7.1%
12.1%
% < 14 years
13.8%
13.7%
% > 65 years
22%
Net migration
-0.3
+0.4
Average age at childbirth
31.9
31.6
 Old age ratio
159.4
157.7
Healthcare costs pro capita
1 794 euro
1 849 euro
VENETO
Chronic
65% of > 65 years
disability
25% of >75 years
Childbirth
37.000
Heart failure
1.5%
Diabetes
5.4%
Cancer mortality
30,9% (-0.4% in 3 years)
Tasso di diasoccupazioen il secodno p
basso d’italia

3. STRATEGIES, TOOLS, PRINCIPAL RESULTS

4. Long-term planning policies
REGIONAL HEALTHCARE PLAN
(2012)
HOSPITAL
(2013)
AND TERRITORIAL
FORMS
(first time)
OBJECTIVES OF GENERAL DIRECTORS 4

5. COST LIMITS & ACTIVITIES
In the Veneto: the use of specific instruments
STANDARD
COST LIMITS & ACTIVITIES
HTA
THROUGH ACTIONS ON
….. “CORE” HEALTHCARE
PROCESSES
Prevention
Hospital care
Specialist
Intermediate care
Primary care
Pharmaceutical
Social
…. SUPPORT PROCESSES
Human resource management
Economic resource management
Balance Management
Management control
Acquisitions 5

6. In the Veneto: STARTING PARAMETERS
Hospitalization:
Hospital Beds:
Ambulatory
Performance:
Personnel:
Pharmaceutical:
Hospitalization rate and compliance with national " hospital standards"
Outpatient service use rate (excluding laboratory)
Economic limit for single organization in
comparison with the national limit
Minimum Care Time
Agreed pharmaceutical cost
Economic limit for single organization on pharmaceuticals and devices
135 /1000
3,5 /1000
4 /1000
limit
MCT
114 pro capita
limit

7. Synthesis Activity Data
2013
2014
2015
2016
Hospital beds /1000 inhab.
3,74
3,78
3,66
3,59
-4%
HOSPITALIZATION RATE /1000 inhab.
134,03
132,42
130,8
130,19
-3%
OUTPATIENT SERVICES
(LAB EXCLUDED )/1000 inhab.
3,89
3,88
3,73
3,5
-10%
AGREED PHARMACEUTICAL
COST PRO CAPITA
120,1
116,5
113,7
-5%
NUMBER OF EMPLOYEES
57.844
57.835
57.679
58.152 1%

8. Governance of the personnel Regional analysis and monitoring
MONITORing of Region
DEFINItion
DGR n. 610 of the 29th of april 2014

9. Hospital costs in the Veneto
Pharmaceutical Costs
Hospital costs in the Veneto
Agreed Pharmaceutical Costs in the Veneto
Fonte: Tabelle monitoraggio spesa farmaceutica AIFA

10. THE NEW EXECUTIVE POLICIES FOR GOVERNANCE OF THE SYSTEM

11. Local healthcare units
1979 (Regional Law 25 October 1979, n. 78)
31 LHU
IN IMPLEMENTION OF
NATIONAL PROVISION
LN 833/1978
1994 (Regional Law 14 September 1994, n. 56 )
21 LHU
IMPLEMENTION OF
NATIONAL PROVISION
D.LGS 502/1992
2017: 9 LHU
1 DOLOMITES
2 MARCA TREVIGIANA
3 SERENISSIMA
4 EASTERN VENETO
5 POLESANA
6 EUGANEA
7 PEDEMONTANA
8 BERICA
9 SCALIGERA
inhab.
inhab.
inhab.
inhab.
inhab.
inhab.
inhab.
inhab.
inhab.

12. 26 2 2 4 2 1 4 4 5 2 New Districts DISTRICTS ART 26, comma 1, 6

13. Council – Assembly – Area –
PLANNING
MANAGEMENT- SUPERINTENDENCE
PROVISION OF
SERVICES

14. Consiglio – Giunta – Area –
PLANNING (ex ante)
REGIONAL COUNCIL
(Regional Laws…)
Consiglio – Giunta – Area –
REGIONAL ASSEMBLY
(Resolution of the Assembly…)
HEALTH AND SOCIAL AREA
(Criteria…)
STRATEGIC PLANNING:
REGIONAL SOCIAL-HEALTHCARE PLAN
RESOURCE ALLOCATION AND HEALTHCARE BALANCE
STRATEGIES OF IMPLEMENTATION AND ORGANIZATION

15. Management-SUPERINTENDENCE (EX POST)
AZIENDA ZERO
(Decrees-resolutions of the azienda zero)
MANAGEMENT OF TECHNICAL-ADMINISTRATIVE FUNCTIONS
MANAGEMENT OF CENTRALISED HEALTHCARE
MANAGEMENT OF INDICATIONS IN THE ECONOMIC-FINANCIAL AREA …

16. 9 LOCAL HEALTHCARE AGENCIES & TREATMENT SITES
PROVISION OF SERVICES
2 HOSPITAL ORGANIZATIONS AND 1 ONCOLOGY INSTITUTE
9 LOCAL HEALTHCARE AGENCIES & TREATMENT SITES
Hospitals
Hub
Hospital unit
Network node
Integration of the network
Districts
Integrated Territories and Medicine

17. ORGANIZATIONAL MODELS

18. Population and costs by level of risk
Very High
20%
High
75%
Low
Healthy user
Non user

19. The reorganization does not modify the model of treatment centres
ACUTE
HOSPITAL BEDS
Regional centres
ACUTE BEDS
3,5‰
Hub
Spoke,
Network node
INTERMEDIATE CARE
3.000 HOSPITAL BEDS
Territorial Rehabilitation Units,
Hospice,
CommunityHospital
INTERMEDIATE BEDS
0,6‰
Greater treatment intensity
RESIDENTIAL CARE
HOSPITAL BEDS
75% minimum intensity
25% average intensity
Nursing Homes
RESIDENTIAL BEDS
6,1‰
HOME
HOME CARE
10,2 ‰

20. 68 structures NETWORK HOSPITAL HUB 2 REGIONAL HUB 5 PROVINCE HUB
admissions 2015
outpatient service
access to first aid
public employees
private employess
2 REGIONAL HUB
5 PROVINCE HUB
1 REGIONAL CANCER CENTER
SPOKE
17 SPOKE PUBLIC HOSPITALS
3 SPOKE PRIVATE HOSPITALS
NODE NETWORK
17 NODE NETWORK PUBLIC HOSPITALS
23 NODE NETWORK PRIVATE HOSPITALS
Precedenti erano
42 PUBLIC beds (84%) beds for extra region patients
68 structures
26 PRIVATE beds (16%) beds for extra region patients

21. Intermediate recovery structures CARE SERVICES NEAREST TO HOME
Hospice
Community Hospital
RTU 21

22. Territorial services COT CA – Doctors on call MGI-Medical homes
COT “Centrale operativa territoriale” coordinate and monitor the transitions between MGI and intermediate hospital structures and long-term facilities
MGI: «MEDICINE DI GRUPPO INTEGRATE» one for people assisted.
multiprofessional team of general practitioners, medical specialists, nurses, related to specialist and guaranteed a 12 hour opening time
MEDICAL CARE
24/24 h
headquarters
CA – Doctors on call
MGI-Medical homes
COT
GPs 3.213
territorial pediatricians 564
COT 21
assisted by district
MGI:310
CA “Continuità Assistenziale” Out-of-hours primary care service.
On call medical doctors providing medical advice and home visits when needed. A free service operating at night and during the weekend

23. THANK YOU