[The new financing system in the Italian National Health Service. Implications for internal medicine].
Since 1995, the Italian National Health Service has begun to fund its hospitals on a DRG basis. This paper presents the main features of the DRG system as well as its likely implications for general internal medicine. The first part describes the introduction of DRGs in the US. The first paragraphs summarize the features of the US health-care system and particularly its private nature with two major exceptions: Medicare and Medicaid. The development of the DRG system and its adoption by Medicare are then described. Finally, the main effects of Medicare's DRG system are underlined: shorter hospital stays, fewer hospital admissions, several diagnostic and surgical procedures shifted from the inpatient to the outpatient setting, and apparently no negative quality implications. The second part focuses on Italy, in general and with specific reference to general internal medicine. For general internal medicine, the new funding system has two major implications. First, it may lead to the creation of larger medical departments including both the current general internal medicine divisions and the various specialties. Second, even under the current organisational structure, divisions will be increasingly required to produce positive financial margins. In this respect, general internal medicine divisions seem to be in a favourable position, especially in terms of costs (both per-diem and per-admission).
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Università Commerciale Luigi Bocconi, Milano.
D003695:Delivery of Health Care; D003953:Diagnosis-Related Groups; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007388:Internal Medicine; D007558:Italy