Top 20 Italian hospitals: where patients go for the most complex treatment

There is a 'backbone' of large hospitals that guarantee the most complex care, attracting patients from all over Italy. This is a physiological phenomenon in a country like ours, where many, too many, small hospitals still exist in large numbers: those with less than 120 beds are still over 150, and those with up to 400 beds around 200. What remains 'pathological', however, is the distribution of these maxi poles of excellence in our healthcare system - between public and private hospitals - which are disproportionately distributed, concentrating mainly in the Centre-North. A fact that encourages so-called 'hope trips', i.e. the displacement of hundreds of thousands of patients who every year move mainly from the South to the North in search of the specialist care they need.

Confirmation of this imbalance comes from the map of the maxi poles drawn up by the technicians of the Ministry of Health and its Dg of Planning Americo Cicchetti using the latest data from the Sdo, the hospital discharge forms just published. This data was used to draw up a top 20 list of large hospitals - not a "ranking" of the best performances, the ministry wishes to clarify - which emerges after selecting the hospitals with the highest number of hospital discharges (11% of all cases of ordinary hospitalisation and day hospitalisation), which are then assigned a score based on a mix of two indicators: the average weight of the Drg case history (the complexity of the cases treated) and the attractiveness of patients arriving from other regions (mobility).

This map sees no less than five hospitals in Lombardy (10 million inhabitants) in this list of 20 top large nosocomas, three of which are concentrated in Milan to occupy the top positions for highest 'score' - the Galeazzi the Humanitas hospital in Rozzano (in the Milanese hinterland) and the Irccs San Raffaele - and only two facilities for the whole of southern Italy (for almost 20 million inhabitants), namely the Casa sollievo della sofferenza hospital in San Giovanni Rotondo (Puglia) and the Monaldi hospital in Naples. Also worth mentioning in the top 20 are three hospitals in Tuscany - the Pisa hospital company, the Siena hospital company and the Careggi hospital in Florence - and three others in the Veneto region (the Verona university hospital company, the Padua hospital company and the Sacro cuore Don Calabria hospital in Negrar) and finally three in Rome, namely the Gemelli, the Campus Biomedico and the San Camillo Forlanini. But the striking fact is that if we also add the Mauriziano hospital in Turin and the San Martino hospital in Genoa, half of the large hospitals in the top 20 are all in the North, while eight are in the Centre (the Sant'Orsola hospital in Bologna and the ospedali riuniti hospital in Ancona are added to the three Tuscan and three in Rome) and only two in the South.

The report just published by the ministry of health on hospital discharges first of all points out that hospitalisation activities have recovered after a drop during Covid when 6.817 million hospital discharges were recorded, rising again in 2022 to 7.646 million and then touching 8 million in 2023 according to preliminary data (7.957 million). Returning to the subject of patient mobility in search of better care, the report also shows that as many as 8.3% of admissions were made in a region other than the patient's region of residence; the share is back at 2019 levels, after falling to 7.2% in 2020, with a slight recovery in 2021 (7.8%). As many as 441,000 admissions outside the Region (considering only those for acute cases): this ranges from 30.4% for Molise, 28.4% for Basilicata and 21.2% for Calabria to 5% for Lombardy, 5.4% for Emilia and 6.2% for Veneto. "This unfortunately shows that still too many citizens mainly from Southern Italy have to move to get the best care and face considerable costs, both economic and psychological," bitterly warns Health Minister Orazio Schillaci .