title: Diagnostic imaging and spending review: extreme problems call for extreme measures.
abstract: The number of diagnostic imaging tests has increased dramatically over the past decade and about 5 billion diagnostic examinations are performed worldwide each year. According to Health Ministry, Italy, is in second place for the number of CT and MR tests per thousand inhabitants in 2014 with a score of 83.3 (only Germany has a higher score, 95.2) that is a long way off from the European average of 46.5. It has also the highest ratio of magnetic resonances per person with 24,6 machines per million inhabitants, followed only by Greece and Finland. The development of the New Health Information System (NSIS) in 2010 made uniformly readable the non-homogeneous clinical data from all the different Italian regions and permitted a detailed analysis of all diagnostic imaging within the public outpatient care setting in Italy in 2012. Despite that MRI examinations represented only the 10% of the total number of imaging tests performed, their cost reached 30% of the health-care expenditure for outpatient diagnostic imaging with an overwhelming contribution coming from musculoskeletal MR which accounted for the 73% of the performed MR tests. It is reasonable to assume that these phenomena are likely due to a lack of appropriateness in MR requests that is difficult to analyze due to an absence or invalid query on the prescriptions which together accounted for the 98.7% of cases. Taking into account the above-mentioned situation, this is possibly why the Ministry of Health decided to perform "linear cuts" in expenditure for some diagnostic examinations.
authors.affiliation: Political Economy, Faculty of Medicine and Surgery, Department of Biomedicine and Prevention, University of "Tor Vergata", Viale Oxford 81, 00100, Rome, Italy.
authors.forename: Anna Micaela
authors.initials: AM
authors.lastname: Ciarrapico
authors.affiliation: General Directorate of Health Professions and Human Resources of the SSN, Ministry of Health, Via Ribotta, 5, Rome, 00100, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Ugenti
authors.affiliation: General Directorate of Digitization, of the Health Information System and Statistics, Ministry of Health, Via Ribotta, 5, 00100, Rome, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Di Minco
authors.affiliation: General Directorate of Digitization, of the Health Information System and Statistics, Ministry of Health, Via Ribotta, 5, 00100, Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Santori
authors.affiliation: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Policlinico Tor Vergata, Viale Oxford 81, 00100, Rome, Italy. simone.altobelli@email.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Altobelli
authors.affiliation: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Policlinico Tor Vergata, Viale Oxford 81, 00100, Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Coco
authors.affiliation: Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Policlinico Tor Vergata, Viale Oxford 81, 00100, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: D'Onofrio
authors.affiliation: Department of Biomedicine and Prevention, Policlinico Tor Vergata, Viale Oxford 81, 00100, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data
keywords: Diagnostic imaging; MRI appropriateness; NSIS; Public outpatient services