Autonomy arrives, but healthcare is already split: insufficient care for 26 million

There is a sort of 'Gothic line' of healthcare that passes under Tuscany and the Marches and divides the country, condemning more than 26 million Italians to receive inadequate care, with 7.5 million - all from the South, including Sicily, Molise, Basilicata and Calabria - forced to rely even on 'highly inadequate' healthcare services. These are impressive numbers in the days when the debate on the differentiated autonomy that has just been approved is heated, given that on balance only 55% of Italians live in regions with satisfactory health protection results, while for 45% things are not going well. The result emerges from the latest analysis of health protection opportunities in the regions, conducted by the 104 experts grouped by Crea Sanità (Centre for Applied Economic Research in Healthcare) and based on data from 20 indicators.

The measurement of regional performance in healthcare is not limited to the evaluation of health and economic aspects, but also analyses the social and equity aspects of care and is based on 20 indicators (with data and numbers collected from the main healthcare databases) divided into five areas: equity, appropriateness, outcomes, innovation, economic-financial and social. The performance index ranges from 0 to 100% with 45% considered the minimum threshold for sufficiency. What emerges? That Veneto, Piedmont, Bolzano and Tuscany (over 13.3 million inhabitants) are 'promoted' with better overall levels of health protection than the others and with a performance index that exceeds 50% of the maximum level (60%, 55%, 54% and 53% respectively). Friuli-Venezia Giulia, Trento, Emilia-Romagna, Liguria, Valle d'Aosta, Marche and Lombardy (19.3 million inhabitants) promoted, but with a sufficiency: they achieve performance levels between 45 and 49 per cent. 'Postponed' with levels between 37 and 44 per cent Sardinia, Campania, Lazio, Umbria, Abruzzo and Apulia (around 18.9 million inhabitants). Highly inadequate (performance level below 35%) Sicily, Molise, Basilicata and Calabria (around 7.5 million inhabitants). It should be noted, however, that looking at the last five years, the performance of the South is clearly improving, but its indices are still very low.

The experts of Crea (for which researchers and university lecturers in the fields of economics, law, epidemiology, biomedical engineering, and medical statistics work) have then devised a 'dynamic' monitoring system to also try to monitor the effects from the North to the South of differentiated autonomy in healthcare, based on a subset of specially selected performance indicators. The monitoring will be fully operational as soon as this is granted to one or more regions, as provided for by the approved law. In the first implementation phase, however, the dynamics on ten indicators selected by the Panel of Experts in groups of Regions were calculated and then compared for the period 2017- 2022: the group of Regions and Provinces or those with a special statute (Sicily, Sardinia, Valle d'Aosta, Friuli-Venezia Giulia and Trentino-Alto Adige with Trento and Bolzano) towards the others, those under a Deficit Recovery Plan i.e. with accounts in the red in healthcare (Abruzzo, Calabria, Campania, Lazio, Molise, Puglia, Sicily) again towards the others and that of the Regions that requested differentiated autonomy in 2017 (Lombardy, Veneto, Emilia Romagna), again towards the others.

The first results were aggregated into 'cumulative' areas of improvement and worsening, weighted with the weights attributed to the indicators by the Panel of Experts, and were summarised, for each group of regions proposed for comparison, in a numerical index: (Weighted Synthetic Index, Isp) with the value '0' indicating an overall compensation between regional improvements and worsenings, the value '1' an improvement for all the regions in the group and '-1' their worsening. In the first comparison concerning Regions and Provinces with special statutes, the Isp is 0.38 and 0.40 for the others. Thus, in the period 2017- 2022 for them the dynamics were (slightly) worse than in the group of the others. In the second comparison, the Deficit Recovery Plan Regions record an Isp Index of 0.44, against 0.37 for the others, thus showing that they have fared better than the others. Finally, in the third comparison, the Regions that have requested differentiated autonomy record an Isp index of 0.36 compared to 0.40 for the others.