La Torre G, Federici A
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
Italian Ministry of Health, Italy.
Public Health. 2017 Dec;153:178-180. doi: 10.1016/j.puhe.2017.09.002. Epub 2017 Oct 16.
Why is Italy one of the world's highest ranked for ability and quality of healthcare in relationship to the resources invested? The last decade has been characterized by many Italian Regions with Recovery Plans, whose main focus was on short-term issues with a high impact on healthcare costs. Italy is now leaving this phase and at the regional level there will be an increase of new hirings in the healthcare sectors, as stated by the Ministry of Health. There is a large amount of scientific literature that supports the role of factors such as lifestyles, diet and genetics as the base of population health. The success of the Italian National Health Service (INHS) function is rooted in the ability of a system to adapt to evolving situations, but it is also important to ensure a mechanism of positive feedback correction. In the future, INHS will require a new set of reforms, like the redefinition of structures and mechanisms of governance, the implementation of strategic plans that conjugate better clinical and financial issues. In this context, Health Data Entanglement could be an option to improve the effectiveness of the health governance system in order to develop better quality of care. In Public Health several criticisms could detonate the bomb, and above all the decreasing levels of primary prevention in the fight to obesity (promoting the Mediterranean Diet and physical activity), to smoking and alcohol consumption, as well as to infectious diseases (promoting high vaccination rates). Secondary prevention is also key to this function as a practical experience of re-engineering of the public expense, giving much attention to what works in terms of cost effectiveness, and in particular to cancer screening.
为何在投入资源方面,意大利的医疗保健能力和质量在世界上名列前茅?过去十年里,许多意大利地区都实施了复苏计划,其主要关注点是对医疗成本有重大影响的短期问题。正如卫生部所说,意大利现在正走出这一阶段,在地区层面,医疗保健部门的新招聘人数将会增加。有大量科学文献支持生活方式、饮食和基因等因素在人群健康方面的作用。意大利国家医疗服务体系(INHS)功能的成功源于一个系统适应不断变化情况的能力,但确保一个积极反馈纠正机制也很重要。未来,INHS将需要一系列新的改革,比如重新定义治理结构和机制,实施能更好地结合临床和财务问题的战略计划。在这种背景下,健康数据纠缠可能是提高卫生治理系统有效性以提升医疗质量的一个选择。在公共卫生方面,一些批评可能会引发问题,尤其是在抗击肥胖(推广地中海饮食和体育活动)、吸烟和饮酒以及传染病(提高疫苗接种率)的斗争中一级预防水平的下降。二级预防作为公共开支重新规划的实际经验,对这一功能也很关键,要特别关注成本效益方面有效的措施,尤其是癌症筛查。