The sustainability of the Lombardia health system

The cœteris paribus trend of growth of the Lombardia Hospital System epidemiological, demographic, economic and financial variables analyzed in this research in the period 1997-2009 is not sustainable in the long-term, for the purpose of this research to the year 2050. Even if in the period 2002-2009 some financial and epidemiological adjustment has indeed been attempted (as highlighted by the Financial Function), in particular with yearly activity budgetary financial constraints and compulsory transfers from acute to ambulatory care (as highlighted by the Epidemiological Function), by means of which short-term financial equilibrium has temporarily been maintained, this same adjustment does not guarantee long-term epidemiological, demographic, economic and financial sustainability (as highlighted by the Sustainability Function). The Italian Ministero dell’Economia e delle Finanze is indeed intervening in curbing the growth rate of public health expenditure by fixing it at a definite percent of the national gross domestic product (circa 7.2%). Most of the savings are based on the reduction of personnel. Since health funds are pooled and equally allocated on a risk adjusted capitarian basis, the same savings will be required on the part of Lombardia. However, if savings are to be made, the underlying epidemiological trends (increase in complexity, invariance in the acute inpatient cases length of stay, increase in intensity), as highlighted by the Epidemiological Function, have to be addressed as well, which introduces the bi-faced question if such savings are sustainable or if their epidemiological effects are acceptable. If there is an almost general consensus among both health operators and regulators in Italy and Lombardia that both effectiveness and efficiency are the main drivers of the long term sustainability of a health system, it appears from the first applications of the model presented here that the Italian and Lombardia Hospital System is still governed by a tendency to manage the short term effects of rising medical, labor and variable costs in general, than by a much more challenging direct intervention into the epidemiological and operational parameters governing the health system in the long term. Certainly, an excellent clinical effectiveness has been achieved, even if, in order to be sustainable in the long term, increases in clinical quality must be proportional to the reduction in the economic waste of financial resources, both in the form of excess costs of the public providers and excess profits in the private ones. Once again, the authors of this paper argue that there can be no health without equity, no equity without quality, and no quality without sustainability.