New Ministerial Decree 70. View of private individuals (Aiop): “Quality and equal access must be the guiding criteria for accreditation”

For private hospitals, the definition of standards for a rational design of the hospital offer and for regional planning oriented towards criteria for quality, efficiency, safety and effectiveness is a remarkable and dutiful effort by the NHS: However, it is fundamental that these criteria are and not others to determine which structures are called to provide services with proven clinical efficacy.

20 JUN

Comments on the revision of Ministerial Decree 70 on hospital standards continue. The Italian Private Hospital Association announced its position and the considerations that have emerged from the technical consultation in the Ministry of Health.

Aiop, represented by the President Barbara citizens, considers it a priority that the selection of providers and therefore their evaluation as well as their remuneration should take place on the basis of criteria based solely on patients’ care needs and the guarantee of fair access to services of documented clinical effect, ensuring – as a cardinal principle in the welfare system – the “public” nature of both the commissioning / protection function or of the subjects called upon to purchase healthcare on behalf of citizen-users, and of the funding system for healthcare through general taxation.

The association’s position paper states, starting from the analysis of the forecast for minimum activity volumes by performance or clinical condition, the need to reconsider the accreditation system and budget allocation mechanism for the structures of the private law component, which automatically places maximum ceilings on NHS benefits. regardless of their actual potential.

According to Aiop, it is an ambitious and difficult task to reduce the qualitative heterogeneity among providers, but at the same time increase the variety and functional specificities that must be pursued to avoid technical operations, evaluate and manage the impact of quantitative requirements on our national healthcare, as real is divided into 21 different and poorly integrated health systems.

Aiop’s reflection, accompanied by impact assessment and illustrated during the technical consultation in the Ministry of Health, is reported in the Association’s position paper, also signed by Aris.

Among the comments and amendments:

Requirements regarding the supply of beds:
the revision of the requirement to provide emergency beds of at least 60 beds, as a threshold for crediting and signing contractual agreements with private law structures;
the reference to “related disciplines” for the correct definition of individual specialist activities for acute care and the confirmation of the threshold of 30 acute care beds laid down in the Prime Minister’s Decree of 1986 for private nursing homes;
the need to consider the specifics of the so-called “mixed” structures, ie. structures with beds for both acute and post-acute, characterized by a high level of specialty and continuity of care

Whose relationship of the standards is to rationalize the hospital network in order to improve the system’s ability to respond to patients’ needs, however, the number of beds has no known correlation with the quality of the service provided. This is the comment from Aiop, which goes on to argue that the consequence is a compression of pluralism that punishes, in the absence of evidence, the private law structures of the NHS characterized by smaller dimensions but perfectly functional and anchored in the territory.

Volume requirements
a study conducted by Aiop in collaboration with Nomisma on the impact assessment – in the form of restrictions on access to care and induced mobility in health care – of the standards envisaged both in the current DM70 and in the revision draft, according to the patient-user perspective ;
the difficulty of evaluating the quantities of private law structures in the NHS, as these quantities are “imposed” by the budget allocation mechanism and are therefore not an indication of the real potential of the offer;
revision of the minimum threshold of 200 interventions / year for isolated aortic coronary bypass procedures in the light of scientific evidence and development in clinical practice.

For Aiop, the cost of streamlining the offer based on safety and clinical efficacy criteria – as evidenced by the DM70’s premises itself – cannot fall on the patient and on his subjective ability (financial and mobility) to contact the structure. hospital is considered “sufficient” if one does not want to translate the search for quality into a pure efficiency of the system at the expense of health and the right to care for patients.

The risk – Aiop continues – is to make the patient abandon treatment and to expand, rather than reduce, inequalities based on geographical and socio-economic variables.

Network of birthplaces
protect and enhance the Hub and Spoke network model – fil red of the entire DM 70 and is considered internationally as the best system to guarantee safety and appropriateness in perinatal care – also for assistance at birth;
applies to all maternity wards the safety standards regarding 24-hour assistance from two units of obstetric staff and two units of gynecological staff, an anesthesiologist and a neonatal figure, as well as the presence of sub-intensive therapy, as provided for in the State Convention – Regions of 2010 for the first time level of birth point.

According to Aiop, the safety of puerpera and the unborn child, in first-place birthplaces – that is, the maternity wards that help pregnancies and physiological births in gestational age beyond 34 weeks – must be pursued by exploiting the full potential of Risk management and through the promotion of formalized orientations towards the care environment appropriate to the level of risk and timely access to equipment that may not be present in first-level birthplaces (such as transfusion centers, general intensive care, neonatal intensive care, multi-specialist counseling).

The Italian Society of Gynecology and Obstetrics (SIGO) also shares the same view, which insists on the centrality of continuity in care and the improvement of the time-dependent network.

June 20, 2022
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