How is the health requirement measured? The demand for performance is different for the various age groups, and in the transition to the standard cost system it takes into account. But you should also consider the difference in sex. Because women live and get sick more.
Since 2009 there is a significant change in the health system: instead of repayments based on “historical expenditure”, in the financing of the expenditure of the regions, the criterion of “standard costs” is adopted. The implications and difficulties are known and discussed in this important passage; Less evident is its probable impact on a gender perspective, which takes into account the different “need for health” between men and women, and its consequences (also) on public spending.
What has changed
The general principle is that the financing of “essential levels of performance” – the so-called “LEP expenditure”, identifiable with assistance, health and education – will no longer occur in relation to historical expenditure (which may also include waste or inefficiencies) But it will be calibrated on the basis of a kind of “fair price” of the various functions carried out at the territorial level, in theory calculated in reference to the sustainable costs by an administration providing services respecting parameters of average efficiency.
In more detail, the definition of standard cost in health is the ideal amount of resources needed to manage the so-called essential levels of assistance (LEA). Therefore the costs of all the benefits to be guaranteed and for each transfer to the regions a corresponding sum will be calculated at the central level. In addition to the essential level, regions can use their own resources to ensure services and performance further than those included in Lea.
The turning point lies in the fact that the regions will receive funding only for Lea not exceeding the standard chosen as the benchmark price. Therefore, through the identification of standard costs, the legislator has the ambitious objective of reducing the expenditure of the NHS (arrived at 112.9 Euro in 2011 from 107.1 in 2008, + 5.4%, general report on the economic situation of the country 2011). In this perspective, the regions ‘ wastefulness and inefficiencies in delivering too expensive public services in relation to national standards will be financed by residents through the tax levy.
But finding out what benefits are essential and what the respective standard costs are is actually a very complex job, as the rich theoretical debate on the subject demonstrates. It would certainly be important to convince yourself that the standard cost-regardless of how it is calculated-is to be configured as the cost necessary to meet the health needs of an average inhabitant, so it would perhaps be more appropriate to talk about the needs Standard, although it is determined at national level and always in compliance with a budget constraint. However, the issue could be more complex than expected in health care, where the production of simple performance and services is distinct from the achievement of clinical results (prevention, care, rehabilitation) and the fulfillment of the need for health. And in defining the need for health of an average inhabitant, one should also take into account the “subjective” factors, the personal characteristics of age, gender, morbidity, sociology-economic condition), geographical, economic and social conditions of the region in which he lives .
The “Need for Health”
The demand for health benefits increases with age: over 65 years consumption can become 8-9 times greater than those recorded in the classes of age 5-14 years. It then becomes difficult to hypothesize the application of the same standard requirements of health care to regions such as Liguria, where the over account for almost 27% of the total, and Campania, in which the population over 65 years It affects about 16% of the total.
For this reason, since 1996 we have begun to take into account the age of the residents, going from the criterion of the per capita quota “dry” (i.e. based on the number of resident citizens) to the per capita quota “weighed” (with age groups as weights). Having introduced the age between the reference criteria is important; But can that be enough? It is actually difficult for the same age class to register across the country as likely to get sick and use health services. Moreover, it should be asked whether the State of health of women-at the same age class-may present characteristics different from that of men, so as to be explicitly considered in the standard cost formula in order to ensure The equality of treatment on a substantial level. Because the correct per capita share only for the age does not distinguish well the health needs of all people, and does not identify gender differences.
According to ISTAT data and Ministry of Health, the Italians are 31.2 million, ie 51.8% of the population, a fairly stable percentage in all regions, while it is more variable within the age classes: 94 women every 100 men under 20 years of age , while between 65 and 80 years of age there are as many as 121 women for 100 men, and you get to 197 women for 100 men over 80 years of age. The proportion of women increases with age because in Italy these live on average almost 6 years more than men. They live more at but with the burden of a greater number of years of life in poor health. Moreover, some diseases have a higher incidence and prevalence among women; Others do not affect women and men in the same way; Still others only affect women. In This scenario, women suffer from greater disabilities linked to chronic diseases and continue to pay a large number of lives to so-called “Big Killers” (heart attack, stroke, breast and lung cancers).
Sifting the latest report on the state of health of Women by the Ministry of Health emerge some facts:
- 8.3% of Italian women denounce a poor health condition against 5.3% of men.
- The diseases for which women have a higher prevalence than men are: allergies (+ 8%), diabetes (+ 9%), cataracts (+ 80%), arterial hypertension (+ 30%), heart disease (+ 5% 9), thyroid (+ 500%), osteoarthritis and arthritis (+ 49%), Osteoporosis (+ 736%), calculus (+ 31%), headache and migraine (+ 123%), depression and anxiety (+ 138%), Alzheimer’s (+ 100%).
- It grows among the girls, more than for the boys, the consumption of alcohol. And the spread of smoking for women, unlike men, increases with the level of education and age.
- Rises the share of women underweight, more than men; The sport and physical activity is less practised by women than men.
- Disability is more widespread among women (6.1% versus 3.3% of men).
- The use of the general practitioner shows, during the period 1996-2002, a slight prevalence of the female gender (58% of accesses).
- The use of Caesarean section is constantly increasing and has gone from 11.2% in 1980, to 29.8% in 1996 and 38.2% in 2005 with considerable variations by geographic area (23.2% in the P.A. of Bolzano and 60.0% in Campania) and the presence of lower values in Italy settentrion Ale and higher in southern and insular Italy.
In addition, the United Nations to the World Bank states that investing in women’s health offers high returns in the form of faster development, higher efficiency, greater savings and poverty reduction. That is, by improving the health of women, governments can give a significant impetus to economic and social development.
In this perspective, one could perhaps rethink the method of weighting used to define the standard costs and to spread the resources for health expenditure between the regions, considering the population to be assisted “in a more unequal way”-Men and women over That young and old–to get to be substantially more equitable.