In 2021, the year affected by the COVID-19 pandemic, the volume of activity provided by Italian hospitals recorded a recovery, although not returning to pre-pandemic levels: in particular, a total of 7,318,874 discharges were recorded, with an increase of +7.4% compared to the year 2020 (which however had seen a reduction of approximately 20% compared to 2019). This is what we read in the Annual Report on Hospitalization Activity (SDO) – Year 2021.
Il SDO report, edited by office 6 of the General Directorate of health planning of the Ministry of Health, every year photographs the hospitalization and acute care activity of Italian public and private hospitals. The source of the data is the New Health Information System (NSIS), the same which, with the numerous information available, allows for example, thanks to the New Guarantee System (NSG) tool, to monitor and verify – according to the size of the equity, effectiveness and appropriateness – that all Italian citizens receive the care and services falling within the Essential Levels of Assistance (LEA).
In general, the number of hospital discharges increases compared to 2020, although not returning to pre-pandemic levels.
The Report highlights the increase in hospital discharges in 2021, both in acute and rehabilitation departments, in both hospitalization regimes (ordinary and day). Long-term care activities are an exception.
In particular:
the acute activity in the ordinary regime (discharges +6.1%, days +5.0%) the acute activity in the daytime regime (discharges +18.4%, admissions +15.7%) the activity of rehabilitation under ordinary regime (discharges +1.3%, days -0.4%) rehabilitation activity under day regime (discharges +21.7%, admissions +38.0%) long-term care (discharges -8.4% , days -10.3%).
Increased hospitalization rate
In Italy, compared to 2020, the total hospitalization rate (acute, rehabilitation and long-term care, ordinary and day care) increases in 2021, standardized by age and sex, going from 99.0 to 107.8 per 1,000 inhabitants. In particular, the acute hospitalization rate goes from 94.5 to 103.3 per 1,000 inhabitants, with a fair amount of regional variability.
Interregional mobility
After the generalized decline in mobility noted in 2020 due to the pandemic, in 2021 the percentage of mobility hospitalizations increased for each type of activity and regime, tending towards pre-pandemic values, but without exceeding them:
7.8% for acute care activities in the ordinary regime (7.2% in 2020 and 8.3% in 2019) and 9.7% in the daytime regime (9.3% in 2020 and 9.5% in 2019 ); 14.6% for rehabilitation activity in the ordinary regime (13.1% in 2020 and 15.9% in 2019) and 10.9% in the day regime (11.0% in 2020 and 10.8% in 2019); 5.6% for long-term care (4.7% in 2020 and 5.9% in 2019).
Trend of theoretical remuneration
Analyzing the trend of the theoretical remuneration of hospital hospitalization services paid by the NHS in the years 2010-2021, an overall gradual reduction is recorded: yes goes from 30.9 billion euros in 2010 to 26.3 billion euros in 2021 (24.2 billion euros in 2020 and 28.4 billion euros in 2019). For the year 2021 there is an increase compared to 2020, although without returning to pre-pandemic levels. In particular, in 2021 the overall remuneration stands at approximately 24.5 billion euros for acute care activities (of which approximately 22.5 in the ordinary regime and 2.0 in the day regime), approximately 1.6 billion euros for the rehabilitation activity (of which approximately 1.5 billion euros in the ordinary regime and 72.5 million euros in the day regime), and approximately 237.2 million euros for the long-term care activity, for a total of approximately 26.3 billion euros (up 8.6% compared to 2020, when the theoretical remuneration stopped at 24.2 billion euros in 2020, but lower than the 28.4 billion in 2019).
It should be noted that the theoretical remuneration of hospital hospitalization services paid by the NHS is estimated on the basis of the hypothesis that each hospitalization is remunerated in each Region according to the values of the national reference rates pursuant to Ministerial Decree 18/10/2012, and that the cases are grouped according to the DRG version 24 classification system.
Use
The interpretation of the data contained in the SDO 2021 Report must continue to take into account the extraordinary conditions linked to the pandemic event, the emergency measures issued to deal with the organizational aspects connected to it and their impact on the use of hospital.
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