Abstract

 
 Background. Sicilian government has developed a very ambitious Reform through the Regional Law n. 5 (14th April 2009). Hospitals were requested to ensure the quality of care through monitoring of appropriateness and quality of service. The aim of this study was to assess variations of efficiency and organizational appropriateness of healthcare delivery before and after this Reform and to show patterns associated to different types of healthcare delivery organizations.
 Methods. This study was based on repeated cross-sectional data for 118 (out of 129) short-term, acute-care, non teaching-and-research Sicilian hospitals, in 2008 and 2010. Congestion and slacks analysis was used, with four inputs, two desirable outputs and two undesirable outputs of healthcare delivery.
 Results. The loss of desirable output increased between 2008 (23%) and 2010 (31%). Most of the variation between two years in the measured inefficiency could be attributed to congestion due to inappropriate care (p=0.009) and scale inefficiency (p=0.028). Hospitals that have undergone an organizational transformation did not show congestion in the study period. Conversely, hospitals with no variations in their organization were congested in association to the shortfall in the ODs (p=0.019) and in DHs (p=0.018).
 Conclusion. This study has shown the general worsening of efficiency of acute-care Sicilian hospitals from 2008 and 2010 and, in particular, has suggested that the reduction of efficiency was due to hospitals that have not undergone an organizational transformation. They are medium-low sized and low-complexity public hospitals and for-profits, while larger and high-complexity organizations resulted the least congested ones.
Highlights
The Italian National Healthcare System (INHS) was introduced in 1978 and has undergone several reforms since 1992, which were intended to increase institutional and financial autonomy while reducing inefficiencies, with the direct assignment of income tax revenue to Regions.Public healthcare in Italy is organized into Hospital Trusts (HTs) and Local Public Hospitals (LPHs), which were defined according to the Legislative Decree 502/92Evaluating the Reform of Sicilian Health System e12593-1(Article 4)
For hospitals that have undergone an organizational transformation, slacks analysis did not show any significant output shortfall or input excess either in 2008 or in 2010. Results of this repeated cross-sectional study for Sicilian acute-care hospitals from 2008 to 2010 showed that there was a statistically significant reduction of total efficiency, which could be attributed to scale and congestion components
The Regional Healthcare System (RHS) Reform occurred in 2009 and has mitigated the overall observed reduction of efficiency in a different way depending on the different types of healthcare delivery organizations
Summary
The Italian National Healthcare System (INHS) was introduced in 1978 and has undergone several reforms since 1992, which were intended to increase institutional and financial autonomy while reducing inefficiencies, with the direct assignment of income tax revenue to Regions.Public healthcare in Italy is organized into Hospital Trusts (HTs) and Local Public Hospitals (LPHs), which were defined according to the Legislative Decree 502/92Evaluating the Reform of Sicilian Health System e12593-1(Article 4). Following the act of the Ministry of Health on the proposal of the Regions, hospitals that are equipped with special functional technical requirements are considered to be HTs. At the end of the nineties, an approach based on Essential Levels of Care (LEAs - Livelli Essenziali di Assistenza) was introduced. Conclusion: This study has shown the general worsening of efficiency of acute-care Sicilian hospitals from 2008 to 2010 and, in particular, has suggested that the reduction of efficiency was due to hospitals that have not undergone an organizational transformation. They are medium-low sized and low-complexity public hospitals and for-profits, while larger and high-complexity organizations were shown to be the least congested
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