Apolone G, Melotti R, Repetto F, Iapichino G
Laboratorio di Epidemiologia Clinica, Istituto Mario Negri, Milano, Italy.
New Horiz. 1994 Aug;2(3):350-6.
Through prepaid compulsory insurance managed by the central government, Italy's National Health Service (NHS) provides full coverage, free accessibility, and no or limited copayment by individuals when receiving health services. Although Italy spends less than other countries on health care (< 8% of the country's gross national product), the present NHS faces considerable difficulties, and its performance regarding quality, outcome, and spending has come under question. ICUs account for < 2% of total hospital beds, and the proportion of ICU patients is < 2.5% of all hospital patients (2.5% of all Italian hospital patients receive ICU care at some time during their hospital stay). Information from administrative databases and epidemiologic studies gives an interesting national picture of the situation in Italy regarding admission criteria case mix, and outcomes when compared with data from other countries. Important changes in the financial and institutional framework of the NHS are underway, yielding an unpredictable scenario for the future. Innovations focus mostly on cost containment and quality initiatives. These innovations will likely produce a new health service in which regions will have a more important role than in the past. Actions planned in a large Italian region by the local government are used as an example to explain the potential impact of this new trend on critical care medicine.
通过由中央政府管理的预付强制保险，意大利国家医疗服务体系（NHS）提供全面覆盖、免费可及性，并且个人在接受医疗服务时无需自付或只需支付有限费用。尽管意大利在医疗保健方面的支出低于其他国家（占该国国民生产总值的比例不到8%），但目前的国家医疗服务体系面临着相当大的困难，其在质量、治疗结果和支出方面的表现也受到了质疑。重症监护病房（ICU）占医院总病床数的比例不到2%，ICU患者占所有住院患者的比例不到2.5%（2.5%的意大利住院患者在住院期间的某个时候接受过ICU护理）。行政数据库和流行病学研究提供的信息，让人们得以有趣地了解意大利在入院标准、病例组合以及与其他国家数据相比的治疗结果方面的全国情况。国家医疗服务体系的财务和制度框架正在发生重大变化，这为未来带来了不可预测的局面。创新主要集中在成本控制和质量改进方面。这些创新可能会产生一种新的医疗服务模式，在这种模式下，各地区将比过去发挥更重要的作用。以意大利一个大地区地方政府计划采取的行动为例，来解释这一新趋势对重症医学的潜在影响。
