Il sistema sanitario nella Regione del Veneto Giampaolo Stopazzolo Direttore Sanitario Azienda Unità Locale Socio-Sanitaria n°5 Ovest Vicentino –Arzignano (Vicenza

Uffici di rappresentanza della Regione del Veneto Venice

Sede del Servizio per i rapporti Socio – Sanitari della Regione del Veneto, Venezia

Veneto Region: Membership of Political Networks The Alpes-Adriatic Working Community Armenia Sunik Austria Carinthia Belgium Flemish Community Bulgaria Varna Czech Republic Usti Silesia-Moravia Germany Lower Saxony North Rhine-Westphalia Hungary Bács Kiskun Györ Moson Sopron Szabolcs-Szatmár Israel Northern Region Italy Emilia Romagna Sicily P.A. Bolzano Veneto Lithuania Kaunas Norway Rogaland Poland Silesia Portugal Madeira Romania Timis (new) Russia Vologda Spain Catalonia Valencia Sweden Västra Götaland Östergötland Switzerland Ticino United Kingdom North West England Northern Ireland, Wales WHO Regions for Health Network, Europe L. Bertinato, Veneto Region

La regione del Veneto 18.390 km 2 4.7 milioni di abitanti Good morning, Ladies and Gentlemen. I’d like first of all to put you all in the picture. This is the Veneto Region, located in the NorthEast of Italy, and bordering on Slovenia and Austria. 18.390 km 2 4.7 milioni di abitanti

The Veneto Region Population Structure (As of the 2001 General Consensus) VENETO ITALY Total population: 4,527,694 56,305,568 Surface area 18,390 Kmq N. Families: 1,699,235 21,503,088 Membri per familglia: 2.62 2.60 Tasso di nascita: 9.3 9.2 Tasso di mortalità: 9.0 9.5 Natural growth rate 0.3 -0.2 Total growth rate: 5.6 1.9 Elderly persons’ 135.7 127.10 index % % population >65 years: 18.5% (compared to a EU average of 14.08%) Total Veneto production facilities: 449.932* (*high proportion of small-medium sized, and family-based companies) As you can see from this summary slide, the total population of the Veneto is 4.7 million inhabitants. It is characterized by a low birthrate, and a substantial elderly population. The regional capital is Venice and major cities are Verona, Vicenza, Padua and Treviso. The Veneto Region is an autonomous territorial organization with legislative powers which, together with the other nineteen Regions, the State and the Autonomous Provinces, make up the Italian Republic. The twenty Italian Regions, five of which have a special statute, were instituted by the Constitution in 1948. C. Matterazzo, Veneto Region

The Veneto Region - The North East “Miracle” Economic Indicators (as of 2004) Total Veneto production facilities: 449.932* (*high proportion of small-medium sized, and family-based companies) Rates of Unemployment: Veneto Region 3.4% Italy 8.7% European Average 9.6% Exports (€millions): €38.637 Imports: €29.310 Gross Domestic Product (€) GDP: National GDP: €113.341,8 million GDP per inhabitant of the Veneto: €24.892 GDP per inhabitant of Italy: €22.016 GDP % growth in 2004 1% prediction for 2005 0% Source: ISTAT – Veneto Regional Government € The Region boasts over 450,000 small to medium-sized companies, which means one company to every ten inhabitants in the Veneto. The Region’s economy has, up to now, been based on these small-medium sized and family-based companies which, after the Second World War, enabled the Region to move from poverty to what was called the Italian NorthEast economic miracle in the 1980s - I only need mention big names such as Benetton, Aprilia, Stefanel, Diesel, and Dainese. After World War II, these small companies transformed the Region from an agricultural area into a rich, industrialised and highly developed one. The rate of unemployment is relatively low compared to the national or European average. Exports far exceed imports, and the GDP per inhabitant of the Veneto is also higher than the national average.

La Regione del Veneto Struttura della populazione VENETO ITALIA Totale populazione: 4,527,694 56,305,568 Superficie 18,390 Kmq N. Famiglie: 1,699,235 21,503,088 Tasso di nascita : 9.3 9.2 Tasso di morte: 9.0 9.5 Indice di anzianità’: 135.7 127.10 % popolazione >65 anni: 18.5% (paragonato alla media Europea del 14.08%) As you can see from this summary slide, the total population of the Veneto is 4.7 million inhabitants. It is characterized by a low birthrate, and a substantial elderly population. The regional capital is Venice and major cities are Verona, Vicenza, Padua and Treviso. The Veneto Region is an autonomous territorial organization with legislative powers which, together with the other nineteen Regions, the State and the Autonomous Provinces, make up the Italian Republic. The twenty Italian Regions, five of which have a special statute, were instituted by the Constitution in 1948.

La Regione del Veneto è divisa in 21 Unità Locali Socio-Sanitarie (ULSS) The Veneto Region is divided into 21 Local Health Units or ULSS

Il Sistema sanitario veneto in numeri 21 unità locali socio- sanitari 2 aziende ospedaliere 89 centri per le prenotazioni ospedaliere 1,076 fornitori di servizi sanitari specializzati 1,307 farmacie 3,600 medici di base 250 case di riposo per gli anziani 19,429 numero di posti letto negli ospedali pubblici(85% del totale regionale) 3,470 posti letto negli ospedali privati (15,15%) Here’s an overview of the Veneto regional health system in numbers: 21 territorial local health authorities 2 hospital trusts *89 centres for patient admissions (=58 public hospitals, 2 of which are Hospital Trusts; 4 private hospitals under the protection of the Local Health Units; 2 IRCSS(cancer research institutes); 7 private hospitals;18 residential care homes operating (and not) under the NHS,(for approx. 20,000 hospital beds and 900,000 hospital admissions a year) 1,076 specialist health care service providers 1,307 pharmacies 3,600 general practitioners 250 residential homes for the elderly 19,429 hospital beds in the public system (85.85% of the regional total) with 3,470 private hospital beds (15,15%)

Il Sistema Sanitari Italiano Copertura universale gratuita finanziata attraverso la tassazione basata sul reddito Organizzato su 3 livelli: NAZIONALE REGIONALE Italy’s health care system is a regionally based national health service, providing universal coverage free of charge at the point of service, and funded through general taxation based on earnings. It is organized on 3 levels: the national, regional and local levels. The national level is responsible for ensuring the general objectives and fundamental principles of the National Health Care System. It sets out the general objectives and guiding principles, as well as ensures the Essential Levels of Health Care provision (ELHC or “LEA”). The national level also has a regulatory function for pharmaceutical drugs and medical equipment In Italy, planning of health care expenditure is performed by the 20 Regions and 2 autonomous provinces. The Regional Health Authorities (RHAs) are responsible for the funding, organization and delivery of health services in their own area. Regional governments, through regional health departments, are responsible for ensuring the delivery of a benefit package through a network of population-based health management organizations (local health units) and public and private accredited hospitals (WHO, 1999). The regional level is responsible for the management and organization of the health system, and is financially accountable. The 1978 reform law n.833, dated 23rd December, 1978, assigned an important role to municipalities which were in charge of governing the local health units. From the late 1980s a series of reforms progressively shifted municipal powers to the regional level. LOCALE:

La responsabilità della Regione del Veneto nelle politiche Socio – Sanitarie Ministero della Salute Ministero per le Politiche Sociale Assessorato per la Sanità e Politiche Sociali 581 Comuni nella Regione del Veneto The Veneto’s responsibility in policy-making in the Health & Social Sector: Since 2001, the Italian State in the Health Care sector has been responsible for defining the National Health Plan and the so-called “ELHC”: the Essential Levels of Health & Social Care provision, guaranteed to ALL Italian citizens; Veneto and the Italian Regions are responsible for public health, health care, and for the social services. They can include additional services (eg. dental treatment) in the basket of health & social services if approved politically. The responsibilities of the Regional government in the health and social sector are shared with responsibilities in the social sector of the 581 Municipalities of the Region. Both have the right to allocate funds and to approve regional and local legislation for vulnerable population groups. 21 Unità Locali Socio - Sanitari 2 Aziende Ospedaliere

21 2 1 Territorial local health authorities Hospital trusts IRCCS The Regional Health Care System: dimensions The population covered is approx. 4,700,000 citizens 21 Territorial local health authorities 101 Belluno 102 Feltre 103 Bassano del Grappa 104 Alto Vicentino (Thiene) 105 Ovest Vicentino 106 Vicenza 107 Pieve di Soligo 108 Asolo-Castelfranco 109 Treviso (Oderzo) 110 Veneto Orientale (S.Donà di Piave) 112 Veneziana 113 Dolo 114 Chioggia 115 Cittadella 116 Padova 117 Este 118 Rovigo 119 Adria 120 Verona 121 Legnago 122 Bussolengo The Regional Health Care System: its dimensions. The Veneto Region Health Care System is classified as a holding to which 21 territorial local health units, 2 hospital trusts (university teaching hospitals of Padova and Verona), and a National Institute for cancer research, and a number of private accredited health care providers all refer. Each of these health institutions has management and administrative autonomy as outlined in Regional Laws n. 55 and 56 of 19th September, 1994. These Laws define the structure of the Regional Health Care System and the new Veneto health care model. 2 1 Hospital trusts IRCCS 901 Az.Ospedaliera di Padova 902 Az.Ospedaliera di Verona IRCCS – Istituto di Ricerca e Cura a Carattere Scientifico – as of 03/2006, institute for cancer research, Busonera, Padova.

21 Il sistema sanitario regionale: dimensioni La popolazione coperta è di ca. 4,700,000 abitanti 21 Unità Locali Socio- Sanitarie 101 Belluno 102 Feltre 103 Bassano del Grappa 104 Alto Vicentino (Thiene) 105 Ovest Vicentino 106 Vicenza 107 Pieve di Soligo 108 Asolo-Castelfranco 109 Treviso (Oderzo) 110 S.Donà di Piave 112 Veneziana 113 Dolo 114 Chioggia 115 Cittadella 116 Padova 117 Este 118 Rovigo 119 Adria 120 Verona 121 Legnago 122 Bussolengo The Regional Health Care System: its dimensions. The Veneto Region Health Care System is classified as a holding to which 21 territorial local health units, 2 hospital trusts (university teaching hospitals of Padova and Verona), and a National Institute for cancer research, and a number of private accredited health care providers all refer. Each of these health institutions has management and administrative autonomy as outlined in Regional Laws n. 55 and 56 of 19th September, 1994. These Laws define the structure of the Regional Health Care System and the new Veneto health care model.

Il sistema sanitario regionale: dimensioni 2 Aziende Ospedaliere 901 Az.Ospedaliera di Padova 902 Az.Ospedaliera di Verona The Regional Health Care System: its dimensions. The Veneto Region Health Care System is classified as a holding to which 21 territorial local health units, 2 hospital trusts (university teaching hospitals of Padova and Verona), and a National Institute for cancer research, and a number of private accredited health care providers all refer. Each of these health institutions has management and administrative autonomy as outlined in Regional Laws n. 55 and 56 of 19th September, 1994. These Laws define the structure of the Regional Health Care System and the new Veneto health care model. IRCCS 1 IRCCS – Istituto di Ricerca e Cura a Carattere Scientifico , Padova.

Investimenti Regionali nei Servizi Socio - Sanitari Il fondo Regionale per la sanità nel 2007: €7.1 milliardi Investimanti Regionali destinato al settore sociale : Per finanziari altri programmi: Assistenza a domicilio Sostegno alle famiglie disagiate Per anziani e cittadini non auto – sufficienti e altre categorie vulnerabili € 520 Milioni The total budget for public health and health care in the Region was 6.7 Billion euro in the year 2005. Out of this, 520 Million was allocated to the Social Sector, to address the needs of more vulnerable groups, examples of whom are shown here. Servizi per le dipendenze

Il contesto Istituzionale Con la legge del 1990 (eg. L 502/1992) è stato trasferito la competenza nella sanità dallo Stato alle Regioni Decreto legislativo n.56/2000 & l’Accordo Stato–Regioni del 8/8/2001 dà più autonomia alle Regioni per monitorare i costi dei servizi sanitari; La Regione deve essere in grado di valutare i dati sui costi sostenuti nel arco dell’anno finanziario in ambito sanitario Institutional Context Legislation of the early 1990s (with particular reference to legislative decree n.502/92) meant a significant transfer of power from the State to the regions, which in turn were granted the freedom to decide on how to spend their health care budget allocation, as well as on how to organize the health care system within the framework of the National Health Plan, in line with the essential levels of health care provision. The State has, as a result of legislative decree 56/2000 and the State-Regions Agreement of 8/8/2001 granted greater autonomy to the Regions, insofar as how to best invest health care resources; giving Regions more responsibility for the monitoring of health service costs, and for adopting the necessary tools to cover deficits; Consequently, the Region needs to access data on costs, both incurred so far and predicted up to the end of the current financial year.

The Ministry of Health performs 5 central functions : Health care planning Health care financing Framework regulation Health monitoring General governance of the National Institutes for Scientific Research L. Bertinato, Veneto Region

Organigramma del sistema sanitario Regionale Segreteria regionale Assessorato regionale Servizi e Uffici regionali ULSS 1 ULSS 2 ULSS n ... 22 Az. Osp. PD Az. Osp. VR Cliniche e Ospedali Privati

Il Modello Veneto I Principali Fornitori di servizi sanitari Dipartimento di Prevenzione Distretto Sanitario Ospedali Livelli essenziali di assistenza includono: Assistenza ospedaliera e ambulatoriale Assistenza specialistica Assistenza farmaceutica Integrazione tra l’assistemza sociale e sanitaria

L. Bertinato, Veneto Region Devolution at Regional level Regional Law 11/2001, putting a State Law into operation (D.lgs. 112/98 “Devolution of State Funcions to Regional and Local Authorities”) modifies the institutional profile of the Regional health service as follows: At the Regional level, a Permanent Regional Conference for social and health care planning is set up, allowing the participation of local Municipatilities. At the level of local health care authorities, the Conference of Mayors is modified. At the district level, within a single local health care authority, a District Committee of Mayors is constituted (as of March 2002). L. Bertinato, Veneto Region

Background The problem: The solution: Drawing up balance sheets for the health budget constitutes a huge workload; Financial information collected from local health institutions is fragmentary and largely unstructured; Management of financial flows among LHUs presents difficulties for the Health Monitoring and Financial Board of the Veneto Region; The solution: Collecting and balancing all accounting data of all LHUs in a single, computerized Regional system A Before & After Scenario: The computerization of the health cost accounting system The problem: A considerable manual workload to organize the balance sheets, the unstructured collection of information coming from the local health institutions, and the manual balancing of financial flows among LHUs are the main difficulties that the Health Monitoring and Financial Board of the Veneto Region has had to face in the day-to-day consolidation and monitoring of the activities of the Regional Health Balance. The solution: to balance all accounting data of all local health institutions in a single, consolidated regional system, and to computerize all accounting data, even those produced by hand on paper.

Computerization & centralization of the Veneto Regional Health Cost Accounting System Move from manual to computerization of balance sheet data collection; Implementation of the SAS Financial Management ® solution: Aims to define and centralize the Regional Health Cost Accounting; Generates greater rationalization of data collection procedures from local health institutions; Enables more time availability for analyzing and monitoring financial & economic trends The computerization & centralization of the Veneto Region Health Cost Accounting System: This represents a move from the manual to the complete computerization of balance sheet data among local health institutions; The Implementation of the SAS Financial Management ® solution aims to define and centralize Regional Health Cost Accounting; It represents a move from manual to the complete automization of balance sheet data collection, as well as the rationalization of data collection procedures from local health institutions; By computerizing the whole cost accounting data collection system, more time can then be afforded to analyzing and monitoring financial and economic trends, and predicting future needs in the health sector. This can also support policy-makers in the field of health in making the right strategic decisions, and thereby improving services to Citizens.

The Regional Network Dedicated CED Palazzo Linetti ULSS LHU HDSL 2 M ATM 34 M ADSL Palazzo Molin Ministry of Health Dedicated The Regional Network represents: a protected system. It uses ciphering protocols (SSL) and moves along a horizontal line (all connected nodes are positioned jointly). It supports horizontal flows between individual local health units and vertical flows between the local health units and the Region, and viceversa. It is also used to provide telemedicine services.

Financial Reporting: Region to State The State is responsible for consolidating all the economic information provided by the Regions to be compiled into a final financial budget document; All the above docs were previously treated PARTIALLY electronically, NOW are completely computerized. Information dealt with automatically – reducing man hours, eliminates certain human errors, both in typing and control – takes away the grind... Save time on menial tasks – we can dedicate more time to computerized systems. Annual Budget Prediction Before 31ST December of each financial year, the Region has to make anticipated income and expenditure predictions for the following year based on financial reports made by all local health units, to be submitted for approval The State is responsible for consolidating all economic information provided by the Regions to be compilted into a final financial report to be presented before Italian and European Institutions