Anesthesia practice for day-case surgery in Italy

Abstract

A NESTHESIA FOR surgical procedures performed on outpatient basis has been traditionally very scarce in Italy because of the universal coverage assured by the National Health Service (SSN) to all Italian and European community citizeDs lawfully residing in Italy. Public hospital costs were paid by the SSN through the local government health departments at the expense of taxpayers and without in depth audit on cost-effectiveness. Performing inpatient surgery was considered safer by caregivers, and it was essentially the only choice for patients. In the early 1990s things began to slowly change, with progressive reduction of available resources for health care and more attention to reduction of costs. However, the traditional feeling of security connected with inpatient activity and the previous lack of substantial constraints had induced in health professionals a state of intellectual satisfaction and no need to seek any further methods, at least in public hospitals. On the other hand, private institutions who were certainly more sensitive to cost-related issues, either for profit or not, started to explore alternate surgical scheduling. In those institutions outpatient surgery, particularly low-difficulty ambulatory surgery, was on the rise. Since late 1994, with the introduction by the SSN of financial reimbursement to regional agencies managing public hospitals based on a kind of Diagnosis Related Group (DRG) system, the situation dramatically changed. The new scenario put pressure on the whole SSN to pursue more cost-effective, efficiency-based handling of surgical cases. Thus, outpatient activity, so far neglected and abundantly overlooked, started to become fashionable.