Essential care, only 11 Regions promoted

The new report cards of the ministry promote only 11 regions for essential care, in the south only Puglia. And prevention, especially during the pandemic, pays the highest price. According to Gimbe’s analysis, Emilia Romagna is in the lead, last is Calabria. Every year the Ministry of Health evaluates the provision of health services – the so-called Essential Levels of Assistance (Lea) – which the Regions must guarantee to citizens free of charge or through the payment of a co-payment.

“It is a real “report card” for the regional health services – he says Nino CartabellottaPresident of the Gimbe Foundation – which makes it possible to identify the Regions promoted (compliant), therefore worthy of accessing the share of the reward funding, and the rejected ones (defaulting)”. coaching by the Ministry of Health which can go as far as the commissioner of the Region.

Out of 100 points, at least 60 must be achieved

Until 2019, the evaluation tool was the so-called “LEA Grid”, which in 2020 was replaced by 22 indicators of the New Guarantee System (NSG), always divided into three areas: collective prevention and public health, district assistance and hospital assistance . For each area a score between 0 and 100 is assigned and the Regions are considered compliant if they achieve a score equal to or greater than 60 in each of the three areas; with a score of less than 60, even in just one area, the Region is classified as defaulting. “Considering that 2020 was characterized by the pandemic emergency – specifies the President – the monitoring of the disbursement of the LEAs was carried out only for evaluation and information purposes, with no impact on the bonus share”.

The difference between regions most and least affected by Covid

Following the recent publication of the “Monitoring of LEA through the New Guarantee System” by the Ministry of Health, the GIMBE Foundation, explains the President “carried out some analyzes both to compare the resilience of regional health services in the year of the outbreak of the pandemic, and to evaluate the differences between the Northern Regions, violently affected by the first wave, and those of the South, in fact spared from this impact thanks to the prolonged lockdown of spring 2020”.

Calabria insufficient in all 3 areas considered

LEA 2020 fulfilments. Only 11 Regions are compliant: Emilia-Romagna, Friuli Venezia Giulia, Lazio, Lombardy, Marche, Piedmont, Autonomous Province of Trento, Puglia, Tuscany, Umbria, Veneto. The other 10 are non-compliant: Abruzzo, Liguria, Molise and Sicily with an insufficient score in only one area; Basilicata, Campania, the Autonomous Province of Bolzano, Sardinia, Valle D’Aosta with an insufficient score in two areas; Calabria insufficient in all three areas.

There is still a gap between North and South

“Despite the greater impact of the first pandemic wave in the north of the country – comments the president – the new “report card” also confirms both the North-South gap, given that only Puglia is among the 10 compliant regions, and the extremely critical conditions of health in Calabria”. It is interesting to note that if some Regions occupy similar positions in the three areas, documenting homogeneous levels of compliance/non-compliance, for others there is an important variability in performance between the areas.

Regional differences in the considered areas

In particular, some Regions are located in identical positions in the three areas (Emilia-Romagna, Friuli Venezia Giulia, Lazio). Conversely, other Regions occupy very different positions in the three areas. For example, Umbria is in first position for prevention, in twelfth for the district area and in eleventh for the hospital area; Liguria in seventh position for the district area, fourteenth for hospitals and nineteenth for prevention; Lombardy is in third position for the district area, in fifth for the hospital area and in fourteenth for prevention; the Autonomous Province of Trento is in first position for the hospital area, third for prevention and tenth for the district area.

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The sum of the total points

Considering that the Ministry of Health does not summarize the assessment of LEA obligations in a single score, the Gimbe Foundation has drawn up a ranking of Regions and Autonomous Provinces by adding up the scores obtained in the three areas and reporting the results in descending order divided into quartiles. “With respect to being compliant/defaulting – comments Cartabellotta – the total score further emphasizes the North-South gap: in fact, in the first two quartiles there are 7 Regions from the North, 3 from the Center and none from the South, while in the last quartile, except for the Autonomous Province of Bolzano, all the Regions are from the South”.

Pandemic: a stress test

Gap 2019-2020. Considering that the NSG has been under experimentation since 2016, the Gimbe Foundation has analyzed the differences between the 2020 and 2019 obligations, in order to assess the impact of the pandemic on the total scores of the Regions, as well as on the three macro-levels of assistance. Compared to 2019, in 2020 the total scores worsened in all Regions – with the exception of the Autonomous Province of Trento and Valle d’Aosta – demonstrating that the pandemic has represented a strong “stress test” for Italian healthcare.

Unsatisfactory results in the South (saved by the first wave)

However, among the Regions that experienced a very violent first wave, the 2019-2020 gap is very small (<10 points) for the Autonomous Province of Bolzano, Friuli Venezia Giulia, Tuscany, Emilia-Romagna; intermediate (10-25 points) for Veneto and Piedmont; high for Lombardy and Liguria (>35 points). On the other hand, 7 of the 11 Regions with a gap of more than 20 points are located in the South, effectively spared by the first wave. “These data – explains the President – confirm that the resilience to the pandemic of regional health services and the ability to provide essential services in 2020 were conditioned (positively) more by the 2019 performance than (negatively) by the impact of the first wave “.

Prevention, the difference is a chasm

With regard to the impact of the pandemic on the three macro-levels of care, considering the whole national territory, the maximum gap between 2020 and 2019 is recorded in the prevention area (-263 points), then in the hospital area (-150 points) ; on the contrary, the district area in 2020 shows a slight improvement (+5 points). “The collapse of prevention – explains the President – is the inevitable consequence both of the scant investments in this area, and of the fact that the already limited personnel in the prevention departments have been employed on the front line in the management of the pandemic emergency “

Narrowed North-South gap

“The launch of the new “report card” – concludes Cartabellotta – precisely in the year of the pandemic returns results that are inevitably conditioned by the management of the Covid-19 emergency. However, three fundamental elements emerge from our analyzes. First of all, the North-South gap does not is reduced despite many Northern Regions having been dramatically affected by the first wave and, at the same time, those in the South having been spared thanks to the lockdown; secondly, the Northern Regions most affected by the pandemic have shown a different resilience, inevitably conditioned by the quality of the pre-pandemic regional health service; finally, the “poor sister” of health care, i.e. prevention, was the one that paid the heaviest bill, in terms of providing essential services”.