Controversy among ASL and Hospitals over Red Bills in Healthcare: A Calendar of Criticisms Exchanged
Buckle up, folks! It's budget time again, and everyone's pockets are running dry. The Region is on a mission to tighten the purse strings, urging managers to make cuts wherever possible to minimize this year's anticipated overspending. This tightening is causing a bit of friction between Local Health Authorities (ASLs) and hospitals. Yep, they're all crunching numbers and casting furtive glances at each other's books to avoid being tagged as wasteful spenders.
Take, for example, the ASL of Turin, which clocked a whopping nearly 100 million in overspending in 2024. But here's the kicker: according to their draft budget, they're forecasting a reversal this year, looking at a deficit of -95 million. Ouch! Now, if you recall, the actual deficit back in 2024 was quite smaller, explain the folks at via San Secondo, as they keep a close eye on both their own accounts and those of Città della Salute and the Mauriziano. The issue seems to be the Region's loss recoupment strategy, which appears to favor hospitals over ASLs.
Per capita loss
To get a true sense of the budget data, it's crucial to relate ASL losses to the resident population: the per capita loss. "Our ASL boasts a per capita loss of 114.64 euros, placing it squarely in the middle of the Piedmontese rankings," says Carlo Picco, the director general. Since 2022, hospitals in Piedmont have been evaluated like hospital companies, considering a ratio between costs and production. Prior to that, the Region covered the losses of hospital companies directly, while since 2022, it's been attributed to ASLs based on the share of use of each individual structure related to their own residents. In 2022, many managers raised concerns, only to be told by the Health Department to relax. However, with the Regional Office struggling to cover the costs year after year, that reassurance, whether justified or not, has evaporated. "This new criterion has resulted in a 49 million penalty on funding for the ASL of Turin in 2024," calculates Picco. Subtracting the penalty, the real loss of the ASL is reduced to 49.9 million, with a per capita loss of 57.85 euros.
The data
The "losses of other hospitals attributed to the ASL of Turin" are listed first, with the Città della Salute leading the pack at 61.5 million, followed by the Mauriziano (17.4) and San Luigi Gonzaga (3.3 million). In the case of Città della Salute, which deals with cases of greater complexity, delegating standard performances to the ASL and the Mauriziano, the cost is proportional to its size. Yet, the question remains: who picks up the tab for this? "Moreover, the resident population should also include patients without a fixed address, those who are housed, those at the Regional Center for Rare Diseases, and other categories of non-resident patients followed by Regional Reference Centers located on our territory" - Picco concludes, having already asked the Region to review the "recharge" mechanism on ASLs (starting with his, the largest). The actual population served by their ASL would be significantly larger, thereby reducing the real per capita loss and possibly indicating that the ASL of Turin is among the most frugal in Piedmont.
- The tightening budget has led to friction between Local Health Authorities (ASLs) and hospitals, as they carefully scrutinize each other's financial records to avoid being labeled as wasteful spenders.
- In the ongoing budget discussion, the ASL of Turin's per capita loss of 57.85 euros is under scrutiny, with Carlo Picco, the director general, arguing that this ranking might change if the resident population was expanded to include various categories of non-resident patients.
- The science of healthcare finance is playing a significant role in Piedmont, as the Region weighs the loss recoupment strategy, which has reportedly led to a 49 million penalty on funding for the ASL of Turin in 2024.
- The health-and-wellness sector intertwines with the world of business and politics, as the budget decisions affect the provision of medical services and the financial stability of institutions like the ASL of Turin. The ongoing budget discussions highlight the need for careful management and strategic allocation of resources, particularly within the context of medical-conditions care.
