Health care outside the Region, when it is really needed and why. The criteria for choosing – WWN

Health care outside the Region, when it is really needed and why.  The criteria for choosing – WWN

Of Maria Giovanna Faiella

Around a million Italians migrate every year (especially from the South) for treatment. Main reasons: poor or poor quality services in the area, long waits for tests and visits. Virtuous example: the number of women undergoing breast cancer surgery outside the Region is decreasing

Far from home to cure themselves, almost always from the South towards the Northin the hope of receiving the best care for your illness. We leave to carry out highly complex surgical interventionsas vertebral arthrodesis, pancreatic cancer or replantation of a limbor to reach the specialized center for your rare disease, but also to have a specialist visit or a diagnostic test such as magnetic resonance imaging, or, again, to undergo chemotherapy or radiotherapy.
It is estimated that i health trips interest, in about a year one million Italians. In 2022, only hospitalizations carried out outside the Region there were almost 630 thousand (compared to 498 thousand in 2020, the year of the pandemic) as revealed by the data from the Health Statistics and Information Flows Office of Agenasthe National Agency for Regional Health Services (see table) .

Source: Agenas, Office of statistics and health information flows – Passive mobility volumes of hospitalizations carried out (from 2017 to 2022) by the inhabitants of each Region outside their own

But it is always necessary to change Region to get treatment? What are the criteria for choosing? Here’s what to know.

Right to benefits included in the Lea, even outside the Region

For health mobility means the possibility of having services included in the Essential levels of assistance (Lea) in public or affiliated facilities in different regions from that of residence.
Mobility: apparent if you receive treatment where you live but reside elsewhere; random if you need urgent care while in other Regions; effective when due to patient’s choice, almost always made due to the lack of supply in his areaas noted by the Court of Auditors.
According to the Agenas Report, people flee above all from Campania, Calabria and Sicily.
Given that a sick person would prefer receive the best care in the hospital near your homeone of his anyway right to obtain a health service outside your own Region.

Complex interventions and centers of excellence

Moving becomes necessary when the choice of place of treatment can make the difference. It occurs when the service you need is not available in your city or region, for example an intervention cardiac surgery or a transplant; or one is missing center of excellence for the treatment of a specific pathology, which can guarantee the best treatment outcomes, relatedalso in the case of surgery to higher volumes of activitythat is, the highest number of specific interventions carried out in a year, as indicated by scientific evidence.
For the highly complex hospitalizations (based on Dr– Homogeneous groupings of diagnoses, i.e. the reimbursement that the Region recognizes to the hospital for each specific activity – editor’s note) the defined healthcare migration acceptable. In this context, the recent highlights Agenas report on interregional health mobilityin 2022 there will be patients move away especially for plant interventions prosthesis which fall within Drg 544 (over 37 thousand hospitalizations outside the Region); For vertebral arthrodesis; For major cardiothoracic interventions with cardiac catheterization and on heart valves. Travel destination of health are above all the accredited private facilitieswhere 74 percent of hospitalizations outside the Region occur.

Hospitalizations a medium and low complexity

The choice to hospitalize far from home also happens for those Dr that Agenas defines medium and low complexity. These are services and interventions that, at least in theory, Region must guarantee, and for which, therefore, it would not be necessary to move. Yet it happens. And, in fact, as the Report highlights, mobility for hospitalizations is due in over 50% of cases to medium-low complexity healthcare needs. To give some examples: in 2022 there were almost 13 thousand hospitalizations outside the Region for interventions atuterus
not due to malignant tumorsmore than 11,300 interventions per obesityapproximately 11,200 on foot (as hallux valgus), over 8 thousand hospitalizations for Drg normal newborn (in hospital for birth).

When you don’t need to migrate

There are also services available in the place of residence but you still have to go outside the Region to obtain them. These are the cases of potentially inappropriate hospitalizations, as Agenas defines them. The primacy belongs to hospitalizations for diagnosis of musculoskeletal system he was born in connective tissue
with more than 16 thousand hospitalizations outside the Region in 2022. But we could avoid migrating for radiotherapy, chemotherapy and other performances and also to make a intervention (for example of cataract) That in your region it is carried out on an outpatient basis. As well as there is no need to go for treatment in neighboring regions if it is close to home – within 50 kilometers, reachable in an hour – there are hospitals that provide answers to that health need.

We also travel to do tests and visits at the right times

The Agenas Report indicates that we also migrate to have outpatient specialist services such as medical visits, laboratory and instrumental tests, therapies. In these cases a greater mobilitycompared to the hospital one, between neighboring regions. Probably the passage to the other side also occurs because it is accessed at the right times to exams such as Tac or RmnWhile in your own Region you have to wait a long time.

Tumors, virtuous case

The data from the Agenas Report, if interpreted correctly by the Regions, allow for understand if people go elsewhere because services are lackingor because they don’t trust those who are thereor why they find them in closer places in neighboring regions. They become useful, therefore, for reorganize the offer of services and performances based on the needs of the population resident. success for the breast cancer: Always fewer women migrate for surgery. The reasons are explained by Maria Pia Randazzo, head of the statistical operational unit and health information flows of Agenas: For breast cancer we are witnessing a decrease in the tendency towards mobility due to Work what is being done with the Regions and the relevant Breast-units (highly specialized breast centers, ed.), with the creation of a regional network of facilities, which allows to the people to have quality care and not go looking for it outside the Region.

How satisfied are the health needs in a Region?

For the first time Agenas has used a new parameter to evaluate the ability of a Region’s healthcare facilities to satisfy the assistance and care needs expressed by its inhabitants. Is called Isdi – Domestic demand satisfaction index. When the value equal to one it means the health facilities of the Region guarantee the quantity of services requested by the population; self greater than one they offer more performance than demand
; if, however, theIsdi less than one, the provision of services does not meet the needs of residents, That they must Therefore move to other territories for their health needs.

Useful for better organizing the production of services

In different regions the production of services and services, from a quantitative point of view, does not respond to internal demand, therefore to the requests of the inhabitants – explains Maria Pia Randazzo, head of the statistical operational unit and health information flows of Agenas -. We wondered if they exist margins of improvement in the production of services, so we did an exercise relating theIsdi for the musculoskeletal area with the occupancy rate of orthopedic beds in public facilities and traumatology (among areas at greatest risk of improper admissions outside the Region, ed). For example, the Basilicata has an Isdi equal to 0.64 (being less than 1, part of the requirement not satisfied, ed) but has an occupation of beds in the public by 66%: it could use the unused beds to respond to unmet demand. On the contrary, the Campania it has a bed utilization rate of over 90% but has an Isdi of 0.86, so it could increase the number of beds (it is already using those available) to meet demand. The Isdi – summarizes Randazzo – could serve to better organize the production of services and performances.
One instrument more available to the Regions to govern avoidable healthcare migration, saving patients unnecessary medical trips, in addition to the economic costs borne by the Regions themselves. The quantity of services offered also has its weight, as underlined Court of Auditors in the 2023 Report on the coordination of public finance: Shortcomings in the provision of servicesboth from the organizational point of view of the structures and the quality of the services motivate a large part of the interregional flowsparticularly from South to North.

Doctors from Bambino Ges are traveling to Calabria for visits

Every year, for treatment, beyond 7,500 Calabrian children reach with their families theChildren’s Hospital From Rome. Alone 15 percent of these young patients – just over a thousand – he needs of a recovery. In the majority of cases they do outpatient visits, tests or day hospitals. It is estimated that for the away trip spending for families amounts overall to approximately 5 million euros.
To care for the little ones in the places where they live, without forcing them to travel when it’s not necessary, last year Calabria Region and Bambino Ges have signed an agreement (which lasts 3 years) For contain healthcare migration e improve response capacity in the area, strengthening the regional pediatric network. It provides, among other things, v
specialist visits of doctors from the Roman hospital in the Calabrian pediatric clinics and a service of teleconsultation for the pediatricians of that Region.

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February 11, 2024 (changed February 11, 2024 | 07:50)

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