Activity Based Funding and Knowledge for efficiency in Italian healthcare system: a case study

In Italy, the traditional method of funding healthcare systems are based on historical spending. This approach has generated serious problems especially in the context of financial constraints. To improve the situation,... [ view full abstract ]

In Italy, the traditional method of funding healthcare systems are based on historical spending. This approach has generated serious problems especially in the context of financial constraints.
To improve the situation, methods based on standard values have been progressively introduced. In many cases, however, the way of calculating such standard values was difficult due to a lack of corresponding with actual situation within healthcare organizations (HO). In addition, only in a few cases HO have technical instrument to assess their own costs using a standard value approach.
To overcome this “empasse” the Friuli Venezia Giulia (one of the twenty Italian Regions) healthcare authorities adopted the so called NISAN model, a type of activity based funding method where the standard values are determined according to average effective cost observed within a group of Italian HO.
Through this method it was possible to reduce undue funding and therefore the global costs. A problem arises when the average/standard value does not reflect the actual situation of different HO., that need to develop a deeper understanding of their costs and processes. This arising need can be considered a positive side effect of the introduction of the NISAN model.
The paper analyses the experience realized focusing on difficulties encountered, the work in process, the benefits expected at the different level of this transition from a traditional funding approach to an activity based approach.