It is not true that Ministerial Decree 70 risks handing over hospital care to the private sector

by Claudio Maria Maffei

If used properly, it will be the necessary tool to manage public-private integration, and to succeed, it will be answered by those responsible for the AIOP document with a similar technical document opening the “reserve”. Shooting randomly at DM 70 will ensure that more and more healthcare services will be provided to the private sector

21 JUN

Almost every day, Quotidiano Sanità reports on interventions from a public health point of view (at least with intentions) at DM 70, which breaks it down instead of criticizing it. The most recent arrival (I must say to my surprise) yesterday was an intervention by Guglielmo Lanza from CGIL, who rejected it as follows: “Even the draft revision of DM 70 repeats the completely wrong assumptions in the original decree of 3.7 beds per capita, defined by the all-economic standard cost criterion. “

Once again, the complexity of the DM 70 system was cleared up with a sentence very similar to the one recently used by the coordinator of the clinical forum: “For this reason, the organizational parameters of the hospitals are sanctioned by Ministerial Decree 70 (DM 70 of 2 April)., 2015), which we hope for an in-depth and radical revision “. Common to these two interventions is the summary nature of the planning.

Much more useful and serious in my opinion, the document from the Italian Association of Private Hospitals (AIOP) on the revision of DM 70 was also published yesterday in Quotidiano Sanità. In this paper, we go into great analytical about the benefits of Ministerial Decree 70 and its revision hypothesis (the brogliaccio that Quotidiano Sanità reported and discussed). The document addresses the benefits of some key points that deserve to be carefully considered because they risk further favoring the flight of professionals and patients from the public to the private sector. The main points concerned are in particular the accreditation thresholds for beds, the restrictions in terms of minimum volumes and performance and the network of places of birth (the latter point is not taken into account here).

The very precise observations of AIOP require a detailed knowledge of the Ministerial Decree 70 and its hypotheses about change and the current nature of the Italian private nursing homes in terms of size, activity and organization to be evaluated. Let us take as our starting point the current “nature” of Italian nursing homes.

It must be said that it has never been the subject of special interest on the part of the Ministry and Agena, so there is no institutional analysis of private hospitalization. There is also a lack of data on the comparison between public and private hospital production, as neither the SDO reports (I point out the incredible delay in publishing the report with the 2020 data) nor the National Performance Program or the Statistical Yearbook of the National Health Service (including this company to 2019 data) perform comparative analyzes of this type. Useful information comes instead from AIOP itself, which publishes its annual Hospitals & Health Report, the last of which is from 2021 and reports 2020 data. year of the SDO report, it is possible to get a more precise idea of ​​the world of Italian private nursing homes characterized – even in the presence of a large regional variation, which is not taken into account here – by:

  • an absolute prevalence of planned activities compared to acute, given that less than 10% of access to the emergency room is managed by private structures (see an ANAAO study published here on QS just over two years ago);
  • reduced size in terms of beds (approximately 85 beds on average among AIOP-affiliated hospitals, source report 2021, data 2018);
  • clear prevalence of surgical activity concentrated on specific types of procedures (primarily orthopedic);
  • by a relative autonomy in the selection of the most convenient production lines in view of their lack of involvement in the emergency / emergency system;
  • the presence of itinerant surgical teams operating in multiple locations inside and outside the region, using the available budget spaces, thus increasing interregional mobility;
  • a narrow involvement of private structures in dealing with new critical conditions during a pandemic due to their nature of structures with a prevailing surgical call and more oriented towards a planned activity;
  • from unavoidable risks of inadequacy (must certainly be demonstrated on a case-by-case basis) given the “monoproductive” nature of some structures.

Admittedly, such a situation entails some systemic benefits for the citizens, for example with a strong contribution to some surgical disciplines, but on the other hand it impairs the public system of professionalism, as the protected conditions provided by Private Nursing Homes together with the best . pay a very convincing siren.

This long preamble serves as a framework for the AIOP proposals, which primarily seek to lower the number of emergency beds that constitute the threshold for accreditation and to sign contractual agreements with local health authorities. This number is currently 60 acute care beds for multi-special nursing homes and is envisaged in the new DM 70 in itinere equivalent to 40 for single-special clinics, structures still awaiting a precise definition.

The AIOP document takes all the good in the old DM 70 (starting from the opportunity to enjoy the protected reserve status) and would like to remove some of the limitations that it gives both in the original and in the current version, which requires in a nutshell to:

  • the limit of 60 acute beds has been redefined by including in the 60 beds also post-acute beds related to acute care activities;
  • for individual specialist structures, an “enlarged” definition is given and the threshold is raised to 30 beds;
  • minimum volumes for structure and operator are calculated in a more “elastic” way;
  • for the outcome indicators, a negative assessment is not given solely for the reason that the cases they refer to are undersized.

Beyond the technical aspects, the basic question is: the private must be brought into conditions similar to the public, or must it be kept as a protected reserve with its own rules and restrictions that keep most structures out of organizational complexity and involvement in the emergency network typical of public structures? If the answer were to be the second, the bleeding from professionals from the public to the private system would increase. And budget constraints will not be enough to stop it, because the insurance company will make sure to compensate for budget reductions should there ever be one.

Therefore, it is not true that Ministerial Decree 70 risks providing hospital care to the private. If used properly, it will be the necessary tool to manage public-private integration, and to succeed, it will be answered by those responsible for the AIOP document with a similar technical document opening the “reserve”. Shooting randomly at DM 70 will ensure that more and more healthcare services will be provided to the private sector.

Claudio Maria Maffei

June 21, 2022
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