by Maria Giovanna Faiella
Around a million Italians migrate every year (especially from the South) for treatment. Main reasons: poor or poor quality services in the area, long waits for tests and visits. Virtuous example: the number of women undergoing breast cancer surgery outside the Region is decreasing
Far from home for treatment, almost always from the South heading North, in the hope of receiving the best treatment for their illness. You leave to carry out highly complex surgical operations, such as spinal arthrodesis, pancreatic cancer or limb reimplantation, or to reach the specialized center for your rare disease, but also to have a specialist visit or a diagnostic test such as magnetic resonance imaging , or, again, to undergo chemo or radiotherapy.
It is estimated that health trips affect around one million Italians in a year. In 2022, hospitalizations carried out outside the Region alone were almost 630 thousand (compared to 498 thousand in 2020, the year of the pandemic) as revealed by data from the Health Statistics and Information Flows Office of Agenas, the National Agency for Regional Health Services (see the chart) .
Source: Agenas, Office of statistics and health information flows – Passive mobility volumes of hospitalizations carried out (from 2017 to 2022) by the inhabitants of each Region outside their own
But is it always necessary to change Region to get treatment? What are the criteria for choosing? Here’s what to know.
Right to benefits included in the Lea, even outside the Region
By healthcare mobility we mean the possibility of having services included in the essential levels of assistance (LEA) in public or affiliated facilities in regions other than that of residence.
Mobility: apparent if you receive care where you live but reside elsewhere; random if you need urgent care while in other Regions; effective when due to the patient’s choice, almost always made due to the lack of supply in his territory, as noted by the Court of Auditors.
According to the Agenas Report, people are fleeing mainly from Campania, Calabria and Sicily.
Given that a sick person would prefer to receive the best care in the hospital near their home, they still have the right to obtain healthcare outside their own region.
Complex interventions and centers of excellence
Moving becomes necessary when the choice of place of treatment can make the difference. It occurs when the service you need is not available in your city or region, for example cardiac surgery or a transplant; or there is no center of excellence for the treatment of a specific pathology, which can guarantee the best outcomes of treatment, correlated, in the case of surgery, also to the greater volumes of activity, i.e. the highest number of specific operations carried out in a year, as indicate scientific evidence.
For highly complex hospitalizations (based on the Drg-Homogeneous groupings of diagnoses, i.e. the reimbursement that the Region recognizes to the hospital for each specific activity – ed.) the healthcare migration is defined as acceptable. In this context, the recent Agenas report on interregional healthcare mobility notes, in 2022 patients moved mainly for prosthesis implantation operations that fall within Drg 544 (over 37 thousand hospitalizations outside the Region); for vertebral arthrodesis; for major cardiothoracic operations with cardiac catheterization and on heart valves. The destination of health trips are mainly accredited private facilities, where 74 percent of hospitalizations outside the Region take place.
Medium and low complexity hospitalizations
The choice to hospitalize far from home also occurs for those DRGs that Agenas defines as medium and low complexity. These are services and interventions that, at least in theory, the Region must guarantee, and for which, therefore, it would not be necessary to travel. Yet it happens. And, in fact, as the Report highlights, mobility for hospitalizations is due in over 50% of cases to medium-low complexity healthcare needs. To give some examples: in 2022 there were almost 13 thousand hospitalizations outside the Region for uterine operations not due to malignant tumours, more than 11,300 operations for obesity, around 11,200 on the foot (such as hallux valgus), over 8 thousand hospitalizations for Drg normal newborn (in hospital for birth).
When you don’t need to migrate
There are also services available in the place of residence but you still have to go outside the Region to obtain them. These are cases of potentially inappropriate hospitalizations, as Agenas defines them. The record goes to hospitalizations for diagnosis of the musculoskeletal system and connective tissue with more than 16 thousand hospitalizations outside the Region in 2022. But it could be avoided to migrate for radiotherapy, chemotherapy and other services and also to have an operation (for example cataract) which in your region is carried out on an outpatient basis. Just as there is no point in going for treatment in neighboring regions if there are hospitals close to home – within 50 kilometres, reachable in an hour – that provide answers to that health need.
We also travel to do tests and visits at the right times
The Agenas Report indicates that people also migrate to obtain specialist outpatient services such as medical visits, laboratory and instrumental tests and therapies. In these cases there is greater mobility, compared to hospital mobility, between neighboring regions. Probably the transition to the other side also occurs because you access tests such as CT scans or MRIs in the right time, while in your own region you have to wait a long time.
Tumors, virtuous case
The data from the Agenas Report, if interpreted correctly by the Regions, make it possible to understand whether people go elsewhere because the services are missing, or because they don’t trust those that are there, or because they find them in closer places in neighboring Regions. They therefore become useful for reorganizing the offer of services and benefits based on the needs of the resident population. success for breast cancer: fewer and fewer women migrate for surgery. The reasons are explained by Maria Pia Randazzo, head of the statistical operational unit and health information flows of Agenas: For breast cancer we are witnessing a decrease in the tendency towards mobility due to the work being done with the Regions and the reference Breast-units ( highly specialized breast centers, ed.), with the creation of a regional network of facilities, which allows people to have quality care and not have to go looking for it outside the Region.
How satisfied are the health needs in a Region?
For the first time Agenas has used a new parameter to evaluate the ability of a Region’s healthcare facilities to satisfy the assistance and care needs expressed by its inhabitants. It’s called Isdi – Domestic demand satisfaction index. When the value is equal to one it means that the health facilities of the Region guarantee the quantity of services requested by the population; if higher than one they offer more services than requested; if, however, the Isdi is less than one, the provision of services does not satisfy the needs of residents, who must therefore move to other areas for their health needs.
Useful for better organizing the production of services
In several Regions, the production of services and services, from a quantitative point of view, does not respond to internal demand, and therefore to the requests of the inhabitants – explains Maria Pia Randazzo, head of the statistical operational unit and health information flows of Agenas -. We asked ourselves whether there were margins for improvement in the production of services, so we did an exercise relating the Isdi for the musculoskeletal area to the employment rate, in public facilities, of orthopedic and traumatology beds (among the areas at greatest risk of improper hospitalizations outside the Region, ed.). For example, Basilicata has an Isdi of 0.64 (being less than 1, part of the need not satisfied, ed.) but has an occupancy of public beds of 66%: it could use the unused beds to respond to unsatisfied demand. On the contrary, Campania has a bed utilization rate of over 90% but has an Isdi of 0.86, so it could increase the number of beds (it is already using those available) to meet demand. The Isdi – summarizes Randazzo – could serve to better organize the production of services and performances.
An additional tool available to the Regions to manage avoidable healthcare migration, saving patients from unnecessary healthcare journeys, in addition to the economic costs borne by the Regions themselves. The quantity of services offered also has its weight, as underlined by the Court of Auditors in the 2023 Report on the coordination of public finance: Deficiencies in the provision of services, both from the organizational point of view of the structures and of the quality of the services, motivate most of the interregional flows, in particular from South to North.
Doctors from Bambino Ges are traveling to Calabria for visits
Every year, over 7,500 Calabrian children and their families reach the Bambino Ges hospital in Rome for treatment. Only 15 percent of these young patients – just over a thousand – need hospitalization. In the majority of cases they do outpatient visits, tests or day hospitals. It is estimated that the overall expenditure for families on travel amounts to around 5 million euros.
To care for children in the places where they live, without forcing them to travel when it is not necessary, last year the Calabria Region and Bambino Ges signed an agreement (which lasts 3 years) to contain healthcare migration and improve response capacity in the area , strengthening the regional pediatric network. It includes, among other things, specialist visits by doctors from the Roman hospital to the Calabrian pediatric clinics and a teleconsultation service for the pediatricians of that Region.
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February 11, 2024 (changed February 11, 2024 | 07:50)
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