What has changed in the National Health Service thirty years after Law 502

Life expectancy increased by about 4 years, reaching 83.6 years, which is among the highest in the world, the neonatal mortality rate was halved and all the main indicators related to the performance of hospital care improved: in thirty years Italians became longer-lived They are now in good health. It is the result that health companies and hospitals have achieved from 1992 until today.

On the thirtieth anniversary of Law 502 Which changed the structure of the National Health Service by introducing health authorities, instead of the old local health units, the Director General’s number, budgeting is a must. Above all because this law was criticized, opposed and challenged in fear, which later turned out to be unfounded, of a company that was more akin to privatization and therefore wholly unsuitable for public health management.

None of this. exactly the contrary. Total health expenditure per capita, from 2000 to 2019, increased by 80% to 3,653 euros. A number that is still low, of course, and far from European numbers: just make a comparison with Germany where about twice that amount is spent, €6,518 per capita. In Italy, spending on health is 13.2% of total public spending compared to 20% in Germany or 19% in the United Kingdom. However, it is also true that in the face of this health spending, the healthy levels of the population are higher.

An international comparison documents one of the highest life expectancies: from 79.9 years in 2000, it rose to 83.6 in 2019, higher than Germany, France, the United Kingdom and Sweden and second in Europe after Spain by 83.9 years. Newborn mortality also decreased from 3.5 per thousand in 2000 to 1.9 in 2019, among the lowest in Europe.

Emphasis also comes from performance indicators for sentinel performance: for example, femur fractures with ability to intervene within 48 hours in ten years doubled from 31 to 66% or cesarean sections decreased from 28 to 22%. Hospital admissions for asthma and diabetes were reduced by 60%, and with out-of-hospital assistance and care, hospitalization days were reduced by 30%.

Before this law, in 1992, there were 659 American companies, and today the reorganization has led to 209 companies. In the face of the decline in public hospitalization facilities, regional structures, i.e. residential and semi-residential buildings, clinics, mental health centers, counseling centers and dialysis centers, have almost doubled.

But the law above all has the advantage of providing the DG number, which is now crucial to the health service because it is able to develop flexible management models and respond promptly to emergencies as demonstrated during the pandemic. In the first few years, there were tenures in the General Manager position of only 12-14 months, with a high turnover of managers and predictable consequences for their ability to exercise their duties effectively. The number then appears to have leveled off: 3.6 years of office on average in 2021 represents a management horizon that is not particularly long, especially in terms of the potential scope of strategic planning, but it approaches 4 years of many general assignments. Territory management.

According to the latest survey (OASI 2021), nearly 90% of the more than 200 managers currently working in Asl, Icrss and Policlinici, have carried out their duties in only one area and only 14% have ten years experience in this position. It is necessary to invest more in this to raise the level of professionalism and ensure a greater “geographic” experience in the regions.