Healthcare, Fontana and Fedriga: 'Hospital-centrism is outdated'

Context

TL;DR

• Lombardy and Friuli Venezia Giulia focus on healthcare sustainability.
• Telemedicine project between Lombardy and Ticino funded with 2M euros.
• Lombardy invests 10M euros in territorial healthcare structures.
• Friuli Venezia Giulia allocates 5M euros for territorial healthcare services.

Key facts

• Event: General States of the Health Economy in Varese.
• Border length: Over 100 km between Lombardy and Ticino.
• Telemedicine funding: 2 million euros for remote medical consultations.
• Lombardy investment: 10 million euros for public and private healthcare structures.
• Friuli Venezia Giulia allocation: 5 million euros for territorial healthcare services.
• EU Directive: 2011/24/EU for patient care in other Member States.
• Public Health Law: March 18, 1994, guarantees universal access to healthcare.
• Future healthcare deficit: 3.5 billion francs by 2025 if current model persists.

The President of Lombardy, Attilio Fontana, and his colleague from Friuli Venezia Giulia, Massimiliano Fedriga, were the protagonists in Varese for the General States of the Health Economy. The event brought together the main actors in the sector to discuss the sustainability of the healthcare system.

The healthcare issue is particularly relevant in the Lombardy region, which shares a border of over 100 km with the Canton of Ticino, Switzerland. The free movement of people and goods between the two regions has led to greater integration of healthcare systems, but also to new challenges.

'Putting more money into healthcare is not the only way to solve problems. Who says that shows they don't know the real criticalities of the system,' Fontana stated. The Lombardy Region President emphasized the importance of revising the healthcare management model, overcoming hospital-centrism and focusing on prevention and territorial care.

A concrete example of how this can work is the telemedicine project launched between the Lombardy Region and the Canton of Ticino. The project, funded with 2 million euros, allows patients to access remote medical consultation services, reducing the need for travel and improving the quality of care.

The Lombardy Region has also launched an investment plan of 10 million euros to enhance public and private healthcare structures in the region. The plan provides for the creation of new territorial care structures and the enhancement of digital technologies for healthcare data management.

Also Friuli Venezia Giulia has launched similar initiatives. The region has allocated 5 million euros for the creation of a network of territorial healthcare services, which will allow patients to access care services closer to their residence.

'Healthcare is not just a matter of money, but also of organization and management' - Fedriga said.

To achieve sustainability and efficiency goals, Italian regions are working on implementing European regulations. The EU Directive 2011/24/EU, for example, establishes rules for the protection of patients receiving medical care in another Member State.

In this context, an operational checklist for patients moving between regions or states is essential:

• Verification of insurance coverage
• Research of accredited healthcare structures
• Control of waiting lists
• Evaluation of available care options

Operational details

According to Fontana and Fedriga, simply increasing resources is not enough: a profound reform of organizational models and medical responsibility is needed. 'Hospital-centrism is outdated, now we need to invest in the territory,' they stated. This means that attention needs to be shifted from hospital structures to territorial services, such as primary care and intermediate structures.

The current situation

In Ticino, like in many other regions, the healthcare system has traditionally been centered on hospitals. However, this approach has shown its limitations, with long waiting lists and excessive pressure on hospital structures. For example, according to data from the University Hospital of Zurich, in 2022, 45% of hospitalized patients could have been treated in territorial structures.

Fontana and Fedriga's proposals

Fontana and Fedriga propose shifting attention to the territory, enhancing primary care and intermediate structures. This could include the creation of polyclinics and intermediate care centers, such as the Mendrisio Intermediate Care Center, which offers rehabilitation and long-term care services.

• Concrete example: In Bellinzona, the municipality has launched a project to create a territorial healthcare hub, which will include a primary care center and an intermediate structure for rehabilitation. The project, with a budget of 10 million francs, will be financed partly with cantonal funds and partly with private funds.

Benefits

This approach could bring numerous benefits, including:

'The goal is to provide more efficient and patient-centered care, reducing pressure on hospitals and improving patients' quality of life.'

• Reduction of waiting lists: With more services available in the territory, patients could be treated more quickly and in structures closer to their homes.
• Improved quality of life: Patients could benefit from more personalized care and closer to their needs, improving their quality of life.

Regulations

The Public Health Law of March 18, 1994, establishes that the Confederation and cantons must guarantee universal access to healthcare services. The law revision, which came into effect on January 1, 2022, provides for an increase in funds allocated to territorial healthcare services, with a budget of 100 million francs for 2023.

Operational checklist

To implement the reform, the following steps would be necessary:

• Planning: Identify patient needs and available resources in the territory.
• Design: Define necessary organizational models and structures.
• Implementation: Create structures and hire necessary personnel.
• Monitoring: Verify service effectiveness and make any corrections.

Comparison of scenarios

A comparison between the current scenario and the proposed one shows that:

• Current scenario: 80% of patients treated in hospital, with long waiting lists and excessive pressure on hospitals.
• Proposed scenario: 60% of patients treated in territorial structures, with shorter waiting lists and improved quality of life.

⚠️ The transition to a more territorial model will require time, resources, and coordination between healthcare system actors. However, the benefits for patients and the healthcare system as a whole could be significant.

📊 Investment in territorial structures could be financed partly with public funds and partly with private funds, as in the case of the Bellinzona project.

💡 A profound reform of organizational models and medical responsibility is necessary to guarantee a more efficient and patient-centered healthcare system.

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Key points

The healthcare system of the future must be centered on prevention and patient care in their territory. This requires greater integration between healthcare and social services, as well as greater attention to the training and updating of healthcare personnel.

Territorial model

The two presidents, Fontana and Fedriga, emphasized the importance of overcoming the so-called 'hospital-centrism' and focusing on a more efficient territorial model. For example, in the Canton of Ticino, the Lugano hospital serves a population of around 200,000 inhabitants, while the Bellinzona hospital covers an area of around 100,000 inhabitants.

• A well-structured territorial model could provide for the presence of polyclinics and health centers in strategic municipalities, such as:
• Lugano, with a health center serving around 50,000 inhabitants
• Bellinzona, with a polyclinic covering an area of around 20,000 inhabitants
• Locarno, with a health center serving around 30,000 inhabitants

Operational checklist

To achieve this goal, it is possible to draw up an operational checklist with the following points:

• Creation of a network of polyclinics and health centers throughout the territory
• Implementation of a computerized management system for appointment booking and patient data management
• Training and updating of healthcare personnel on new technologies and methodologies

Comparison of scenarios

⚠️ A recent analysis showed that, if the current model is not changed, Switzerland could record a deficit of 3.5 billion francs in the healthcare sector by 2025. On the other hand, the implementation of a more efficient territorial model could reduce costs by 10-15% and improve the quality of care by 20-25%.

Regulations and amounts

The Swiss regulations on the healthcare sector provide that each canton must guarantee equitable and universal access to care. The Federal Public Health Law (LPPS) of March 18, 1994, establishes that cantons must provide basic health coverage for all residents.

'We must work together to create a more efficient and equitable healthcare system,' the two presidents concluded.

Future prospects

For more information and to calculate your salary, visit our salary calculator. The goal is to create a healthcare system that is more efficient, more equitable, and more sustainable for the future.