Hospitals for Children
Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics.
The National Ministry of Health is the major health care provider in Italy, and the health care system is mainly financed through general taxation. It is regionally and locally managed, and it provides universal coverage for comprehensive and essential health services. Italy’s National Health Service (Servizio Sanitario Nazionale [SSN]) was established in 1978 and replaced the previous system of state insurance established in the post Second World War years.
The pediatric health care system in Italy is part of the National Health System, and it is described in the classical 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care.
Pediatric Primary Care and First Access Care
First access care and most primary care pediatrics in Italy developed during the last 40 years largely based on the concepts of family-centered and family-oriented care. This resulted from an increased awareness of the importance of the psychosocial and developmental needs of children and the role of families in promoting the health and well-being of their children. The latter, with the inclusive aim of extending the responsibilities of the pediatrician to include health promotion, screening, assessment, as well as referral of parents for physical, emotional, social problems, or health risk behaviors that can adversely affect the health and emotional or social well-being of their child.
Primary care includes general first-access care for children and adolescents (0-16 years), which is provided by physicians, primary care pediatricians (PCPs) paid through a state collective agreement. It is organized in a national “family pediatrics” network. Such a system was established in 1981. Since then, the Italian National Health Service has provided pediatric primary care to children through the PCPs, who are commonly called family pediatricians (pediatri di famiglia). The Italian Public Health Care System requires that all children have an identified primary care provider, depending on the patient’s age. Italian pediatricians related to the Public Health Care System work in their own private offices, providing primary care of patients from birth to 16 years of age and are compensated under a capitation system, based on the number of children registered with each PCP. Pediatricians working for the Public Health Care system are usually the sole patient entrance to public secondary and tertiary care in range of 0-6 years of age, and parents can choose between a pediatrician and a GP for their children who are between 6 and 16 years of age.
The whole Italian territory is divided into 708 health districts. Most of them are covered by PCPs. However, in some districts without PCPs, pediatric primary health care is provided by GPs or other medical specialists. Following a recent agreement between the Ministry of Health and the PCPs network,7 2 new functional structures, called functional territorial aggregation (FTA) and complex primary care unit, will be implemented in order to further integrate the various duties and activities of PCPs and promote a more efficient interaction between PCPs and pediatric hospital and specialty centers.
First Access Care
First-access care for children <7 years old is mandatorily provided by PCPs. Care for children >6 years of age is provided either by pediatricians (70%) or by other health care providers (GPs, internal medicine specialists of the state network) with no direct cost to the patient but a copayment is involved if a subspecialist consultation is provided.
First-care access is provided by Family Pediatrics from Monday through Friday from 8:00 a.m-8:00 p.m. and from 8:00 a.m.-2:00 p.m. on Saturday in their offices. These services are provided to all patients free of charge. Pediatricians, as well as GPs in the Italian SSN, are not allowed by law to take care of their patients during hospital admissions.
Secondary Care in Children’s Hospitals
Italy has a long tradition of providing hospital care. For example, the Innocenti Hospital (ospedale degli innocenti), in Florence, was the first pediatric hospital established in Europe thanks to the funding received for charitable purposes from a few Florentine business families (Albizzi and other wealthy families). It was designed by the architect Filippo Brunelleschi and was inaugurated on January 25, 1445. Today, it still provides pediatric care; it is now the headquarters of the United Nations Children’s Fund Innocenti Research Center. After the unification of Italy as a state in 1861, pediatric hospitals and pediatric hospital units (PHUs) were established during the second half of the 19th century, generally funded by private funding (banks, private benefactors). Only from the beginning of the 20th century did they become progressively integrated in the national health system. In Italy, PHUs admit children 0-18 years of age. The National Health Plan issued by the Ministry of Health in 2000 planned for a ratio of 1 PHU/200 000 people (including adults and children)
Tertiary Care and Highly Specialized Children’s Hospitals
Pediatric specialty care is provided in specialized PHUs within public civil or academic general hospitals and in children’s hospitals. In such settings, specialists in pediatrics with an interest (often exclusively) in a particular organ or intervention usually provide care for specific chronic or acute diseases. These pediatricians, with specific expertise in a given specialty coordinate the care for children with complex or rare chronic conditions, working in teams with general pediatricians, psychologists, dieticians, and therapists and other professionals as required by the child. Teams of hospital pediatricians and nurses provide most out-of-hours care for children with chronic illnesses. Subspecialty care is rarely offered to children by adult or general internists.
In Italy, there are 12 children hospitals of which 3 are classified by the Ministry of Health as institutes for pediatric care and clinical and basic research (Istituti di Ricovero e Cura a Carattere Scientifico). They are based in Genova (Istituto Giannina Gaslini), Trieste (Ospedale Burlo Garofolo), and Rome (Ospedale Bambino Gesù).