Langiano T, Martin S J
Health Planning Department, Ministry of Health, Roma, Italy.
Int J Artif Organs. 1998 Nov;21(11):726-9.
The reform process underway within the Italian National Health System is aimed at making decision makers responsible for appropriate and efficient resource utilisation and at ensuring quality of care, eliminating conflict between fairness, quality and cost control. The risk for the quality of the services provided entailed by resource rationalisation is avoidable and controllable. This article explains how the Italian NHS has managed the reform process assuring quality improvement, and describes the policy and the tools adopted. As well as involving all players and the system as a whole in constant improvement, the Italian NHS's policy in pursuing quality of care is based on the adoption of a wide range of measures: measurement of health care and of clinical outcomes, systematic data collection, team work and protocols. The tools adopted, currently under implementation, to support quality control are: an integrated system of indicators for measuring efficiency and quality of NHS structures (demand and accessibility indicators, resource related indicators, activity indicators and result indicators); compulsory accreditation as a prerequisite for health care providers; a system to monitor and control the effects of the new prospective payment system; clinical guidelines (each related to a specific clinical problem); a menu of services (Carta dei Servizi) released by all NHS accredited service providers with full information and warranties regarding the services provided and their quality.
意大利国家卫生系统正在进行的改革进程旨在让决策者对资源的合理高效利用负责，并确保医疗质量，消除公平、质量和成本控制之间的冲突。资源合理化所带来的服务质量风险是可以避免和控制的。本文解释了意大利国家卫生系统如何在确保质量提升的同时管理改革进程，并描述了所采用的政策和工具。除了让所有参与者和整个系统持续改进外，意大利国家卫生系统追求医疗质量的政策还基于采取一系列措施：医疗保健和临床结果的衡量、系统的数据收集、团队合作和协议。目前正在实施的用于支持质量控制的工具包括：一个衡量国家卫生系统结构效率和质量的综合指标体系（需求和可及性指标、资源相关指标、活动指标和结果指标）；医疗服务提供者必须获得认证；一个监测和控制新的前瞻性支付系统效果的体系；临床指南（每个指南都针对特定的临床问题）；所有获得国家卫生系统认证的服务提供者发布的服务菜单（《服务宪章》），其中包含有关所提供服务及其质量的完整信息和保证。
