La riforma del Sistema Sanitario Ligure: alcuni strumenti per la misurazione dell'impatto economico

Ligurian healthcare policies have an essential rule in the Italian background: indeed, Ligurian median age is higher than the Italian median age (49 years vs 45,4 years, according to Istat January 1st, 20219). Moreover, the Ligurian share of the elderly population (people aged over 65 years) is one of the most elevated (28,5% vs 22,8% in Italy, according to Istat 2019). Compare with the other Italian regions, Ligurian healthcare system faced ageing population problem in advanced, with all the implication concerning the increasing healthcare needs. These characteristics make Liguria a sort of pioneer in the adoption of some reforms; for this reason, results interesting to study some peculiar aspects. Three chapters compose this work. The first chapter aims to analyse the recent reform of the Ligurian Regional Health Service. The new organisational structure is based on a network model in order to cope with the complex patients' needs and their paths of care. The reform has maintained the previous Local Health Authorities (LHA), but their activity is now coordinated by a new holding organisation, A.Li.Sa. and by the Regional Departments (DIAR). The goal of the research is twofold. Firstly it is described how A.Li.Sa and the University have cooperated in facilitating the change through an extended training activity. Secondly, the aim is to evaluate the first impact of the reforms concerning a specific case involving the cardiovascular surgical area. The second chapter studies the Ligurian Breast Units' network, given that Liguria is one of the first Italian regions to have realised it. This network is specialised in the prevention, diagnosis, and care of breast cancer with a methodology based on an integrated approach to the disease (Disease management), which has the aim to improve clinical outcomes and services' quality. The objective of this study is to evaluate the Breast Unit network impact in terms of some indicators: appropriateness, quality, efficiency, costs of diagnosis path, and healthcare spending. In closing, the third chapter analysed Patients' mobility, that is a critical issue for universalistic healthcare systems, which are organised by decentralised institutional structure and are financed by general taxation. In Italy, healthcare mobility is a right for the patient who is free to choose the healthcare provider (dlgs. 502/92) with the purpose to guarantee the equity of access. The principles of equity of access and financial sustainability generate a trade-off which characterises the patients' mobility. The healthcare mobility is a debt toward the other regions that have provided the healthcare services. This study aims to analyse the main drivers of interregional patients' mobility for surgical procedures of hip and knee substitution and to define homogeneous mobility risk groups.