The Emergency Rooms and Emergency Medicine should not be the answer to the weakness of the Italian National Health System

Dear Editors, The COVID-19 pandemic has highlighted several and wellknown limits of the Italian national health system, including the weakness of the territorial medical services and the absence of dedicated structures for patients affected by chronic or end-stage diseases in need of long hospitalization, or with social difficulties. [...]

Inter-Regional Hospital Patients’ Mobility in Italy

Background: The federalization of the Italian National Health Service (NHS) gave administrative, financial, and managerial independence to regions. They are in reciprocal competition according to the “quasi-market” model. A network of independent providers replaced the state monopoly. The NHS, based on the Beveridge model in which citizens are free to choose their place of treatment, was consolidated. The aim of our research was to analyze the fulfillment of need for hospital services on site and patients’ migration to hospitals of other regions. Material and Methods: We analyzed data from 2013 to 2017 of Hospital Discharge Cards (HDCs) provided by the Ministry of Health. The subjects of the analysis (catchment areas) were the hospital networks of every Italian region. The study of flows was developed through Internal Demand Satisfaction, Attraction, Escape, Attraction, Absorption, and Escape Production indexes. Graphic representations were produced using Gandy’s Nomogram and Qgis software. Results: In the studied period, the mean number of mobility admission was 678.659 ± 3.388, with an increase of 0.90%; in particular, the trend for ordinary regime increased 1.17%. Regions of central/northern Italy have attracted more than 60% of the escapes of the southern ones. Gandy’s Nomogram showed that only nine regions had optimal public hospital planning (Lombardy, Autonomous Province of Bolzano, Veneto, Friuli V.G., Emilia-Romagna, Tuscany, Umbria, Latium and Molise). Conclusion: The central/northern regions appear more able to meet the care needs of their citizens and to attract patients than the southern ones.

Cost per responder for risankizumab vs secukinumab in patients with moderate-to-severe plaque psoriasis in Italy

Purpose: The objective of this analysis was to compare the cost per responder between risankizumab and secukinumab among patients with moderate-to-severe plaque psoriasis in Italy. Methods: The clinical efficacy was assessed based on IMMerge study of published efficacy data as measured by Psoriasis Area and Severity Index response (PASI 90 and PASI 100) for risankizumab and secukinumab. The treatment cost was based on the number of administrations dispensed in the first (induction plus maintenance period) and the second (maintenance period only) year of treatment and the ex-factory price of each treatment. The cost per responder was adopted as a cost-effectiveness indicator. Results: Independently of the PASI response (PASI 90 and PASI 100) used and the year of treatment considered, the cost per responder was consistently lower for risankizumab compared to secukinumab in all clinical measures. For example, considering the first-year costs and PASI 100, the cost per responder for risankizumab was € 24,506.83 compared to € 38,000.00 for secukinumab. The differences in the cost per responder between risankizumab and secukinumab increased when higher PASI response levels were considered. Conclusion: This economic evaluation suggested that the cost per responder is consistently lower for risankizumab compared to secukinumab from the perspective of the Italian National Health Service in the treatment of moderate-to-severe plaque psoriasis.

The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

Factitious disorder is classified as one of the five aspects of somatic symptom disorders. The fundamental element of factitious disorder is deception, i.e., pretending to have a medical or psychiatric disorder, but the enactment of deception is considered unconscious. Indeed, volition, i.e., the perception of deliberate deception, is blurred in patients presenting with factitious disorder. In the USA and the UK, factitious disorder has received constant media attention because of its forensic implications and outrageous costs for the National Health Systems. Unfortunately, a comparable level of attention is not present in Italian National Health System or the Italian mass media. The review analyzes the classifications, disorder mechanisms, costs, and medico-legal implications in the hope of raising awareness on this disturbing issue. Moreover, the review depicts 13 exemplification cases, anonymized and fictionalized by expert writers. Finally, our paper also evaluates the National Health System’s expenditures for each patient, outlandish costs in the range between 50,000 and 1 million euros.

Development of a municipality index of environmental pressure in Campania, Italy

The Experimental Zooprophylactic Institute of Southern Italy (Istitituto Zooprofilattico Sperimentale del Mezzogiorno, IZSM) is a public health institution operating within the Italian National Health Service. Over the past 5 years [IZSM] has promoted several research studies and interventions in an effort to tackle the ‘Land of Fires’ phenomenon, caused by the continued trafficking and uncontrolled incineration of waste that has affected some areas of Campania for decades. In this article, a mathematical model that generates a municipality index of environmental pressure is presented. The model was developed by a multidisciplinary team led by an environmental engineer and included researchers in the fields of veterinary and human medicine, biology and computer science. This model may serve as a geostratification tool useful for the design of human biomonitoring studies, although it may also be employed for strategic planning of remediation programs and public health interventions.

The medicalisation of politics or the politicisation of pedicine: the case of italian struggles to design public healthcare institutions

In the present article, we reflect on some key aspects for the design of pub­lic health systems by retracing the history of the Italian National Health Service, or Servizio Sanitario Nazionale (SSN), from its inception to the present days, analysing how a series of subsequent reforms and counter-reforms impacted its functions and services. Our reflection is based on a collective interview with Fulvio Aurora, Paolo Fierro and Edoardo Turri, three members of Medicina Democratica, which has been and continues to be one of the key organizations in the struggles for keeping health a public value in Italy. While our standpoint on the issue of health is geographically situated, we believe that an analysis of the Italian healthcare sector, with its success­es and its failures, can offer important points of departures for identifying some key characteristics to shape contemporary approaches to healthcare design that can be translocal and cosmopolitan in their application.

Corneal transplant during COVID-19 pandemic: the Italian Eye Bank national report

To investigate the impact of Coronavirus Disease-2019 lockdown on the Italian Eye Bank organization. In this national retrospective, multicentric, cohort study, data from the Italian Eye Bank during both the lockdown and the first month after the lockdown period were retrieved. We compared the Italian Eye Bank metrics with the same timeframe of 2019 and 2018. Data from 13 out of 13 (100%) Italian Eye Banks were included in the analysis. A statistically significant reduction in the number of donor corneas retrieved in 2020 was found as compared to the same period in 2019 and in 2018, respectively (2020 = 1284; 2019 = 3088; 2018 = 3221; ANOVA: p < 0.0001). Only 534 corneas have been distributed by Eye Banks during the COVID-19-lockdown period (2020 = 534; 2019 = 1220; 2018 = 1237. ANOVA: p < 0.0001). Similarly, the number of wasted corneas due to postponed or cancelled surgeries was 421, resulting in a considerable increase as compared to the previous 2 years (2020 = 421; 2019 = 67; 2018 = 84; ANOVA: p = 0.0035). Overall, 45 donor corneas were rejected in accordance with the guidance of the Italian National Health Institute Italian National Transplant Centre (CNT). SARS-CoV-2 pandemic has profoundly affected every social and medical field, including the Eye Bank procurement and distribution programs. The current data collected from all the Italian Eye Banks highlights the present and the forthcoming difficulties that the Eye Bank community is going to experience, as for the ongoing pandemic.