[A call for organizational and managerial changes in primary and hospital care services].

The changing epidemiological situation and socio-economic conditions in Italy have led to a situation where the Italian health care system no longer adequately satisfies the actual needs of society. Organizational and managerial changes in both primary and hospital care are needed and are proposed in this article. As regards general practice and primary healthcare it is crucial that a stable and exclusive relationship between GPs and their patients be regained through continuous and qualified care by the GP. This can be achieved through the establishment of primary care structures where a team of general practitioners work in association with nursing personnel for the delivery of key services including continuous at-home assistance. As for the organization of hospital care it would be useful to set up, in addition to existing general hospitals, "zonal inpatient facilities", resembling the old "infirmaries", directed by a specialized nurse and with a small full-time medical staff. In these facilities, designed for brief hospitalizations of patients with chronic conditions, GPs could take part in the management of their patients. Two important results could be achieved by establishing such facilities: a substantial reduction of healthcare costs related to frequent hospitalizations of patients with chronic medical conditions, and a structural reorganization of existing hospitals. Presently hospitals are often too large especially considering the continuous progresses made in diagnostic and therapeutic techniques which allow consistently shorter lengths of hospital stay and consequently, a more rapid turnover of patients.