Department of Life Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy.
Ann Ig. 2023 Sep-Oct;35(5):602-610. doi: 10.7416/ai.2023.2561. Epub 2023 Mar 3.
Sars-CoV2 epidemic was the cause of death of more than 180,000 Italian citizens. The sever-ity of this disease showed to policymakers how easily Italian health services, and particularly hospitals, could be overwhelmed by requests and needs from patients and the general population. As a consequence of the clogging of health services, the government decided to allocate a consistent investment to the com-munity and proximity assistance with a specific section (Mission 6) of the so called "National Recovery and Resilience Plan".
The aim of this study is to analyse the economic and social impact of the Mission 6 of the National Recovery and Resilience Plan, with particular regard to the most relevant interventions (Community Homes, Community Hospitals, Integrated Home Care), in order to understand its future sustainability.
A qualitative research methodology was chosen. Documents containing all the relevant information regarding the sustainability of the plan (called in short "Sustainability Plan") were taken into consideration. In case of missing data regarding the potential costs or expenditure of the afore-mentioned structures, estimates will be made reviewing literature for similar healthcare services, already implemented and active in Italy. Direct content analysis was chosen as the methodology for data analysis and final reporting of results.
The National Recovery and Resilience Plan states that it will create savings of up to €1.18 bil-lion thanks to the re-organization of healthcare facilities, the reduction of hospitalizations, the reduction of inappropriate access to the emergency room, and the containment of pharmaceutical expenditure. This amount will be used to cover the salaries for the healthcare professionals employed in the newly planned healthcare structures. The analysis of this study has taken into account the number of healthcare profes-sionals that will be needed to operationalize the new facilities, as described in the plan and compared them with the reference salaries for each category (doctors, nurses, other healthcare workers). The annual cost for healthcare professionals has been stratified for each structure, with the following results: € 540 million for the personnel of the Community Hospitals ("Ospedali di Comunità"); € 1.1 billion for the personnel of Integrated Home Care Assistance ("Assistenza Domiciliare Integrata"); and € 540 million for the personnel of Community Homes ("Case della Comunità").
The expected € 1.18 billion expenditure is implausible to be sufficient to cover the cost for salaries of all the healthcare professionals needed, which is expected to be around € 2 billion. The National Agency for the Regional Healthcare Services ("Agenzia nazionale per i servizi sanitari regionali") calculated that in Emilia-Romagna (the only region in Italy to have already implemented a healthcare structure based on the one described in the National Recovery and Resilience Plan), the activation of Community Hospitals and Community Homes reduced the rate of inappropriate access to emergency rooms by 26% (while in the National Recovery and Resilience Plan expectation is a reduction of at least by 90% for "white codes", the identified code for stable and not urgent patients). Moreover, the hypothesis for the daily cost of stay in the Community Hospital is roughly € 106, while the average current cost in the active Community Hospitals in Italy is € 132 (much higher than the National Recovery and Resilience Plan estimate).
The underlying principle of the National Recovery and Resilience Plan is highly valuable since it strives to enhance the quality and the quantity of the healthcare services in the country that are too often left out of national investments and programs. Nevertheless, the National Recovery and Resilience Plan has critical issues due to the superficial prevision of cost. The success of the reform appears to be established by decision makers and by their long-term prospective, oriented to overcome the resistance to change.
Sars-CoV2 疫情是造成 18 万意大利公民死亡的原因。这场疾病的严重程度向决策者们展示了意大利卫生服务部门，特别是医院，是多么容易被患者和公众的需求所淹没。由于卫生服务的拥堵，政府决定在所谓的“国家复苏和弹性计划”中专门划出一个部分（任务 6），为社区和临近援助提供一致的投资。
本研究旨在分析国家复苏和弹性计划任务 6 的经济和社会影响，特别是最相关的干预措施（社区医院、社区医院、综合家庭护理），以了解其未来的可持续性。
选择了定性研究方法。考虑了所有关于计划可持续性的相关信息文件（简称“可持续性计划”）。对于上述结构的潜在成本或支出的数据，如果缺少数据，将通过回顾意大利已经实施和正在运行的类似医疗保健服务的文献来进行估算。选择直接内容分析作为数据分析和最终报告结果的方法。
国家复苏和弹性计划表示，通过医疗设施的重新组织、减少住院治疗、减少对急诊室的不适当访问以及控制药品支出，将节省高达 11.8 亿欧元。这一数额将用于支付新规划医疗结构中雇用的医疗保健专业人员的工资。本研究的分析考虑了计划中描述的新设施所需的医疗保健专业人员数量，并将其与每个类别的参考工资（医生、护士、其他医疗保健工作者）进行了比较。按每个结构划分了医疗保健专业人员的年度费用，结果如下：社区医院（“Ospedali di Comunità”）人员费用为 5.4 亿欧元；综合家庭护理援助（“Assistenza Domiciliare Integrata”）人员费用为 11 亿欧元；社区家庭（“Case della Comunità”）人员费用为 5.4 亿欧元。
预计的 11.8 亿欧元支出似乎不太可能足以支付所有所需医疗保健专业人员的工资，预计这一数字将达到 20 亿欧元左右。国家区域医疗服务机构（“Agenzia nazionale per i servizi sanitari regionali”）计算出，在意大利唯一已经实施了基于国家复苏和弹性计划中描述的医疗结构的艾米利亚-罗马涅地区，社区医院和社区医院的启用将急诊室不适当访问率降低了 26%（而在国家复苏和弹性计划中，预计“白码”的访问率至少要降低 90%，“白码”是为稳定且不紧急的患者指定的代码）。此外，社区医院每日住院费用的假设约为 106 欧元，而意大利现有社区医院的平均当前费用为 132 欧元（远高于国家复苏和弹性计划的估计）。
国家复苏和弹性计划的基本原理是非常有价值的，因为它努力提高该国医疗服务的质量和数量，而这些服务往往被国家投资和计划所忽视。然而，由于对成本的预测过于肤浅，国家复苏和弹性计划存在一些关键问题。该改革的成功似乎取决于决策者和他们的长期前瞻性，旨在克服对变革的抵制。
