In Vicenza the best local health authority, in Vibo Valentia the worst: healthcare is still split in two

Among the patients of the Asl of central Naples the rate of avoidable mortality, that linked to the quality of care and prevention such as the use of vaccines, is even double that recorded among the patients of the Asl Pesaro-Urbino (29.1 per cent against 14.6 per cent). While in the Reggio Calabria local health authority area people wait an average of 35 minutes for an ambulance to arrive, compared to 14 minutes in the Genovese local health authority area, and while the Imola local health authority reaches 18 per cent of over-65s with home care, in the Messina local health authority area coverage is only 2.2 per cent. Lastly, in the Asl of Trento, breast screening reaches 76% of the target, compared to a meagre 1.4% in the Asp of Reggio Calabria. These are some clear examples of how the Italian healthcare system is still split down the middle, as emerges from the data updated to 2023 presented by Agenas.

The best healthcare companies in Italy are five and they are all in the North, three of which are in the Veneto region, namely the Asl 8 Berica in Vicenza; the Ats of Bergamo; the Asl Euganea in Padua, the Dolomiti in Belluno and finally the Asl of Bologna. While the worst are all in the South (two in Calabria): the Asl Napoli 1 centro and then those of Crotone, Matera, Enna and Vibo Valentia. More generally, out of 110 ASLs assessed by the National Agency for Regional Health Services, 27 facilities were promoted, 53 achieved sufficiency and 30 failed. The five top hospital companies are divided between the North and the Centre: Santa Croce e Carle in Cuneo; the Azienda ospedaliera universitaria di Padova; the Policlinico Tor Vergata and the Sant'Andrea di Roma and finally the Policlinico San Matteo di Pavia. The Agenas database also shows the five worst, all in the South: Ruggi d'Aragona (Salerno), Dulbecco (Catanzaro), Civico Benfratelli (Palermo), Sassari and Moscati (Avellino). In this category, 13 facilities were promoted, 25 with an intermediate evaluation and 13 failed.

But what are the Agenas report cards based on? It is a 'multidimensional assessment of managerial performance'; in particular, for the 110 local health authorities, 34 indicators classified in 6 areas (prevention, district, hospital, economic and financial sustainability, outcome) were examined. Under the lens, for example, the percentages of screenings (breast, cervix, colon) carried out on the target population, which show that 'the local health authorities of the north-eastern regions register a high level of screenings carried out compared to the local health authorities of the central and southern regions, which present low average values,' Agenas warns. Performance is more homogeneous in the district area (primary care; taking charge of the territory; avoidable hospitalisations, etc.) and in the hospital area (average stay in internal medicine and geriatrics departments; escape index for services of medium and low complexity; compliance with waiting times for certain operations).

In the economic-financial area (per capita costs and payment timeliness index), the territorial differences return once again: here, in fact, "the performance of the ASLs of the Centre-North registers higher levels than those of the South", Agenas warns. On the other hand, almost all the local health authorities "with very few exceptions" are doing badly in the area of investments, i.e. the capacity for technological renewal and the state of their assets. Finally, in the last area examined, that relating to the so-called 'outcome' (the results of care), the assessment of the indicators of preventable and treatable mortality shows "how mortality rates are much lower in the Centre-North, with the exception of the Lazio Region local health units, than in the South". The result of the mix of all the areas analysed thus leads to the identification of 27 health authorities with a high performance level, 53 health authorities with an average performance rating, 27 with a low rating.

With respect to the monitoring of hospital companies and hospital-university companies, the indicators taken into consideration are 27 classified into four areas: accessibility, organisational processes, financial sustainability and investments. For accessibility, compliance with waiting times for certain surgical operations (including four operations for cancer) and two indicators relating to the emergency department (length of stay and drop-outs) were examined, and it emerges that there are five companies with the highest performance "concentrated in northern regions (Piedmont, Lombardy, Veneto and Tuscany)". From the second area it emerges how good performance is 'more present in companies in the north and in central Italy'.