half of hospitals fail the test. Here is the map

ANCONA The flip side of the coin. The national outcome program for 2024 developed by Agenas, which examines the data on the activities of 2023, has established for the third consecutive year the University Hospital of Marche on the top step of the podium of the best public hospitals in Italy, this time ex aequo with the Careggi of Florence. And it has also certified other healthcare excellences in our territory: the hospitals of Pesaro and Macerata, for example, have managed to guarantee «timely access to coronary angioplasty within 90 minutes in patients suffering from heart attack acute myocardial”.

INSIGHTS

Lights and shadows

The Jesi facility then entered the Olympus of the 14 structures capable of maintaining very high standards in the last four years for patients over 65 operated on for femoral neck fractures within 48 hours of first access. But the positive notes are counterpointed by the discordant ones. The same Agenas matte monitoring also highlights the flaws in our chiaroscuro healthcare system. In particular, the shortcomings in oncological surgery, which also translates into another coefficient of passive mobility in the segment concerning malignant tumors. Before going into detail about the various structures and their performances, a necessary premise must be made.

And volumes

The evaluations put in black and white in the National Outcomes Program do not only take into consideration the quality of care, but also the volume of interventions of the structure: if it is lower than the threshold established by the Ministry of Health and Agenas, the evaluation will be negative even if the quality of care is high. «The rationale of this evaluation responds to a precise principle – explains Claudio Maria Maffei, former health director of Umberto I, from 1997 to 2002, and today regional health representative of the Democratic Party – the complex case studies must be concentrated in a few hospitals and not dispersed on the territory. This is because to treat pathologies such as oncological ones you need a robust organisation, a structured team. Instead, in the Marche we divide up the activities and these are the results.”

The outcomes

Results which, for oncological surgery, tell of public hospitals in the Marche with low or very low compliance with the standards established by the Ministry in over half of the cases. In eight out of 15 facilities, to be precise. A very low rating goes to Inrca, both in the Ancona and Osimo centers, and to the hospitals of Jesi, Civitanova Marche and Camerino. Low compliance with the standards, however, in the structures of Ascoli Piceno, San Benedetto del Tronto and Pesaro. The maximum marks – that is, a very high level of compliance with the standards – are obtained only by Torrette and the Fano hospital.

The private

The three private facilities that also deal with oncological surgery fare worse: very low ratings for Villa Anna, Villa Pini and Villa Igea (the latter excels in everything else despite). The other aspect in the shadow of the 2024 National Outcomes Program concerns mobility. «For the vast majority of malignant tumors, passive mobility is high or very high, as well as for bone marrow and kidney transplants and for orthopedic prostheses».

The exodus

This means that many people from the Marche, faced with a diagnosis like this, prefer to turn to structures outside the region. Hospitalizations across the border for malignant cancer of the esophagus were 12 in 2023, or 80% of the total; for that of the pancreas, 33 (56.9% of the total). Malignant breast cancer is the one with the lowest percentage of passive mobility (11%), but in any case 208 preferred to be treated for this pathology which is unfortunately increasingly widespread outside the Marche region. On the other hand, active mobility cannot compensate for the diaspora. In 2023, no one came to the Marche from another region to receive treatment related to esophageal malignancy and just six did so for stomach cancer (3.9% of the total hospitalizations).

The dispersed resources

Low percentages also in cases of malignant tumors of the lung (4.9%), kidney (5.9%) and breast (6.4%). On the other hand, passive mobility has always been the nightmare of Marche healthcare: it has drained over 400 million euros from the coffers of the regional healthcare system in 10 years. A monster sum that could have been invested in strengthening services for citizens but which instead inflated the pockets of other regions, Emilia Romagna and Lombardy above all. Considering that over the next two decades an increase in the absolute annual number of new oncological diagnoses in Italy has been estimated at 1.3% for men and 0.6% for women (especially for prostate and breast cancers) correcting the aim of this segment of healthcare becomes an essential task.