Tuscan healthcare system: performance indicators improve, but critical issues remain regarding accessibility, appropriateness, and sustainability
The Management and Healthcare Laboratory (MeS) of the Sant'Anna School of Advanced Studies in Pisa, in collaboration with the Tuscany Region, ARS Toscana, and ISPRO, has presented the updated results of its performance assessment of the Tuscan Regional Healthcare Service for the year 2024.
The overall picture shows positive signs, with approximately 71% of the nearly 200 indicators monitored showing improvement or stability compared to 2023. In particular, there has been a general shift in composite indicators toward the middle of the performance target range. Home care received an excellent rating.
The results were presented in Florence during the conference 'The Tuscan Healthcare Performance Evaluation System', attended by Simone Bezzini, Councilor for Health and Healthcare for the Region of Tuscany, Milena Vainieri, Scientific Director of the MeS at the Sant'Anna School, and Sabina Nuti, Full Professor of Economics and Business Management at the Sant'Anna School.
The conference provided an opportunity for strategic discussion between company management, regional executives, and the Department of Health.
Improvements in emergency room admissions
In 2024, there was an overall increase in outpatient services, particularly follow-up visits, which exceeded 2019 levels. Total admissions rose to 502,072, still 8% lower than pre-COVID levels, but with a significant recovery in surgical admissions. The efficiency of hospital stays also improved: in many hospitals, the number of days spent in both surgical and medical wards decreased, indicating that the system is better able to optimize care pathways..
The issue of accessibility to outpatient services
For first visits, the rate fell from 63% in 2023 to 60% in 2024, while the rate for diagnostic tests improved from 60% to 64%. Unattended departures from the emergency department remained stable at 3.9%.
Clinical and pharmaceutical appropriateness: lights and shadows
In terms of appropriateness, it should be noted that musculoskeletal MRIs rose from 21 to 23 per 1, 000 inhabitants, and repeated MRIs from 5.4% to 6.1%, while antibiotic consumption in children increased by 10%, from 2.5 to 2.76 DDD per 1,000 children, and finally polytherapy with more than 10 drugs reached almost 8% of the population over 65.
Clinical care pathways: oncology and maternal and child health in the spotlight
The oncology pathway shows good overall results: in general, waiting times for priority procedures (breast, rectal, uterine, melanoma, thyroid) have improved, while for colon cancer, where the volume of activity has increased, waiting times are slightly longer than in the previous year. Post-surgery follow-up for breast cancer has also improved, with mammograms increasing from 84% to 86.8%, and the use of telemedicine for cancer check-ups is beginning to spread.
In maternal and child health, the percentage of vaginal deliveries after cesarean section (from 25% to 27.5%) increased, indicating greater attention to the physiological process even after a previous cesarean section. Indicators relating to the use of cesarean section remained stable, and the appropriateness of episiotomy improved (8.4%). Pediatric hospitalizations for asthma and gastroenteritis have also improved (from 31.4 to 27.4/100,000), although there has been a slight increase in tonsillectomies (from 195 to 205/100,000).
The chronic care pathway shows mixed results: hospitalizations for conditions that can be treated on an outpatient basis decreased, while emergency room visits for chronic patients increased.
A healthcare system under economic pressure
The increase in healthcare spending, equal to +5.06% in the fourth quarter of 2024, is in line with the national average (+5.35%). However, economic and financial sustainability indicators are deteriorating, signaling a growing imbalance between costs and revenues.
“The evaluation system is a dynamic and strategic tool that we constantly update to make it more readable, timely, and useful for the governance of the healthcare system. This is why we introduced the 'Elderly and Fragility' program with the aim of addressing one of the main challenges facing contemporary healthcare systems, namely the aging population,” said Professor Milena Vainieri, head of the Management and Healthcare Laboratory at the Sant'Anna School of Advanced Studies in Pisa.
