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2018 Conference Presentation

Care integration Italy

12 September 2018

Nursing homes and hospital care: is there a (missing) link? Evidence from the Italian NHS about failures in intermediate care settings

Elisabetta Notarnicola, CERGAS SDA Bocconi School of management, Italy

Francesco Longo, CERGAS SDA Bocconi School of management, Bocconi University
Giovanni Fosti, CERGAS SDA Bocconi School of management
Alessandro Furnari, CERGAS SDA Bocconi School of management


Background: Many European countries are facing reforms in their health systems tackling a reorganization in settings of care, aimed at broadening the capability to answer to specific care and health related needs and making the system more efficient in order to match a specific need with the proper setting of care. In the Italian NHS, at the regional level, several efforts have been made to improve to network of care across acute, intermediate and primary care settings. Hospitals have been reshaped and often reorganized in order to specialized on severe and acute needs, whereas the cummunity care settings have been pumped and improved in order to better address less sever needs, together with chronic conditions and long term care needs. If these policy objectives have been clearly stated and were strong in their intended objectives, everyday observation of what happens in hospitals and other settings suggests that the “perfect division” that was designed is not working, and this is particularly true when it comes to long term care and elderlies.

Objective: The objective of the study is thus to analyze what is happening in hospital care and community care in terms of elderlies’ use of care services and check if the re-organization of the different settings of care has produced an improvement in the matching between specific care needs with the most proper care settings.

Methods: To do that our study is based on descriptive statistical analysis on national health care records for the year 2015 and 2016. The Italian NHS collects every year data about hospitalizations in all the public hospitals, collecting information about the typology, reasons and result of the hospitalization and characteristics of the patient. Using these data in comparison with regional data about the use of community care settings, will allow us to investigate if and how the reorganization of care settings has produced an effect in elderlies’use of services or not.

Results: Preliminary analysis show that, even in those regions where the hardest efforts in reorganizing services for the elderlies towards community care have been made, elderlies still suffer of an high level of under-treatment and are often assisted in hospitals or in setting that are not appropriate for long term care needs.

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