Country’s healthcare system in a nutshell

Italy's healthcare system is consistently ranked among the best in the world. Life expectancy is the 4th highest among OECD countries and the world's 8th highest according to the WHO. Healthcare spending accounted for 9.7% of GDP in 2020.

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The public system is a regionalised National Health Service, that provides universal coverage to all citizens and legal residents. The central government provides overall stewardship, sets the national benefits package, and allocates funding for the regional health systems. The regions are in charge of financing, planning, and provision of services at the local level

Public vs private

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In 2021, hospital care relied on 995 healthcare facilities, of which 51.4% were public and the remaining 48.6% were accredited private facilities.

The Italian National Health Service has over 214 thousand regular inpatient beds, of which 20.5% are in accredited private facilities. There are 12,027 spots for day hospital care, nearly all of which are public (88.6%), and 8,132 spots for day surgery, predominantly public (76.7%).

The national PHR

History

From a normative perspective, the Italian National PHR, called ‘Fascicolo Sanitario Elettronico (FSE)’ has been introduced from Art. 12 of Law Decree 18 Oct 2012 n. 179 ( “decreto crescita”, converted into law 17 Dec 2012, n. 221). The law established that:

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Even before this law, some Regions already started projects to realise local FSEs (e.g. Emilia Romagna region).

Features

It’s hard to define the features of the Italian FSE because, as discussed in the following paragraph, each regional FSE has different ones.

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• the Transplants Informative System ( Sistema Informativo Trapianti - SIT, a digital infrastructure for managing data regarding the National Transplants Network);

• the Italian Vaccine Registry;

• “CUPs”: regional centres for appointment management.

Challenges and areas for improvement

In the last 2 decades, some Regions have started initiatives to realise platforms for the collection of clinical records produced by their healthcare institutions. The adoption of different processes, the development of different architectural and technological models, and the different level of advancement of these projects is the reason why, until now, interoperability hasn’t been reached.

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The image below shows in black, what already exists, and in grey, is the hypothesis of intervention. This shows that there are regional registries and a platform for interoperability. However, there’s no central data repository, no national registry, and no structured data (which ideally, as stated in the picture, should be in FHIR format), making the interoperability platform unusable.

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Published outcomes - statistics

https://www.fascicolosanitario.gov.it/en/monitoring

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• in 10 regions (including one autonomous province), there are no healthcare facilities that add data to the FSE of its citizens.

• In 6 regions less than 60% of healthcare facilities do that.

• In only 4 regions, the percentage is more than 60%

Screenshots

Note: the screenshots refer to the FSE of the Emilia Romagna region, which, at the moment, is the one showing the highest utilisation.

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• personal data

• my clinicians

• consents

• delegations: share the management of your FSE with one or more people of your choice (delegates).

• auto testing (covid test)

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Bibliography

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Posteraro, N. (2021). La digitalizzazione della sanità in Italia: uno sguardo al Fascicolo Sanitario Elettronico (anche alla luce del PNRR). FEDERALISMI. IT, 2021, 1-42.

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