Levico Terme conference on the future of European health system between private and pubblic.
Held in Levico Terme, on September 24, 2011, in the beautiful setting of the Thermal Palace, the conference «The new frontiers of European health system – free of pateints Moviments in the Member States of the European Union between pubblic and private» which was attended among others by the national administrations of AIPO (National Association of Private Hospital) and (Hospitalitasion Union Européenne de l ‘Priveeé) :. lawyer were present Enzo Paolini Gabriele proffessor Pelissero, Doctor Sciachì Alberta and Giuseppe Puntin)
Absolut important actions MEP Braghetto Iles, who was one of the architects of the Directiv European project a right to cross the I healthcare border, and the top leaders of the national world andinternational thermal (Ennio Gori, President of the thermal world, Massimo Tedeschi, President of the National Association of Student common thermal and thermal spas in legal and scientific: Alceste Santuari, Alberto Lalli e Paolo Gruppo.
He has contributed to its policy and administrativ of Healt Trentina (Alderman Ugo Rossi, President General Medical Giuseppe Zumiani, vice president of the Council of Claudio Eccher, Director General of Health and Flower Company Luciano Trentino AIOP Provincial President Carlo Stefanelli).

BULLETIN 2011 nr. 5
Patrimoni finally brought their experience and professionalism of the Rai journalist Maria Concetta Mattei, who has interviewed Ennio Gori reviewing the main stages of national and international Cures, which in many respects coincide with the engineer Carier Gori, which can be seen now as the great expert of international Cures and Nadio Delai President parteciping Ermeneia to discuss a rundtable and develop an individual relationship of the various national problems wich involve national health in particular the efficiency of the various regional
gambling and the prospects of private sector Devolopment of health care, especially in the hospital.

The center of almost all relationships are put on the Directiv mantionded on the application of patients’ rights to cross-border healthcare, in Official Gazette pubblishead Europen Comunity April 4, 2011 which obliges
Sto transpons member in the national legislaion later than 30 months after the publication status: it means that by October 2013, all EU countries must take measures to ensure that every European citizen access to health of each states with funding from the State. Priciple that also applies to the thermal efficiency of medicine.
The new rules state that people in the EU for me reimbursed for receiving medical assistance in another Member State, provided that the corresponding trattament and costs in their home country. Also thermal cures therefore can be used in bathrooms across Europe Therma always provided they are within the benefist ready to be paid on the cost of the health system of the country of origin of the curist.
The serach to health care, especially oversas could benefit patients on waiting lists, or those who are unable to find specialized treatment to individuals Home Request high levels of health organization and technology is not present in the provinces originally. Members have also improved
rules for cooperation in the field of rare diseases.
a time of great Intersed sholud that in just a few Yeras Harmonization opens and
homogeonization different health system of individual EU states, today so diverse, both
in terms of the foundation under the «efficiency and timing of medical care and services.
The health system in individual European countries are based mainly but one thousaund
aspects that differ from each other, two models of financing:
the first, the so-called Beverigde model, which is based on the general sense that the imposition pubblic
and the agreement haelth trought private powerd by state taxpayers that serves as a control
and the provision of benefits, the second, called Bismark system, providing private funding
secutity system, which is mandatory for citizens with a clear private competitor and pubblic
– Based Compulsory insurance – Compatibility of general taxation
(Social Health Insurance) for workers and (tax-financed)
employer (social destruction). – The State directly organizes network
– The supplies are made by insurence of public property and services
company directly or throug conventions. operated
– Europens countries: Austria, France – The state can establish contacts with private
Germany, Luxembourg and the Netherlands – European countries: Britain,
Switzerland. Ireland, Greece, Italy, Spain
Portogual countries of Northern Europe
Image 1: Bismarck and Beveridge model
The Beveridge system was adopted in English-speaking countries in Latin (Italy, Spain, Portugal)
and Greece, while Bismarck has taken root in the countries of Germany, Holland speech
Very interesting what is happening in Germany where there is a progressive privatization
the doctor who has led many public hospital closing, controlled by Lander, contemporary
and the gradual expansion of the private health system, with the implementation of real holding
enterprise, exchange listed securities, which are advancing in the acquisition of public hospitals and
restructuring and discontinued operations.
The result is that, for the same GDP / health expenditure, which is in line with the average of most
developed European countries, the German health services are of high quality and high efficiency
lists’ Waiting essentially nonexistent.
The German health care system
· Overcapacity: 6400 in 2005 (Netherlands, 3100) caused sub-state
the reduction planning «of hospital stays.
· Progressive increase in the presence of public and private hospitals tend to buy less
efficient to increase «budget» insuranc available: between 1996 and 2007 the number of
public hospitals decreased by 31.3%, the hospital social «profit» was reduced
18.8%, while that of «benefit» private hospitals has grown by 40.6% in line with beds and
hospital with the creation of chains of private hospitals (Spa) some of which are cited
in the stock market.
· Lack of funding of public hospitals of the Earth (has been reduced by 28% compared to
period 1991 – 2008)
· The hospital services are financed 90% by public insurance (GKV) and 10% by private companies
insurance (PKV).
· Between 1991 and 2007 the number of hospitals are reduced by 13%, the number of
beds was reduced by 23.8%, the average stay fell 40.7% increase in the
number of admissions of 17.9% (DRG introduction since 2000).
· Costs9 lowest for staff (contract farm work, with incentives »
meritocracy «for employees based on efficiency and results not bound for
national collective.)
• Greater autonomy and investment in the short term with the reinvestment of
capital gains.
· Management of the «economic» logic is not bound by political-social with top management
· Benefits of participation in «the big chains» with greater bargaining power with
suppliers of goods and services and the ability to attract capital by issuing
actions or collection on the market.
In the Netherlands the new health reform, effective from 4 years, has been proposed organization
privatization push health mediated insurance system by assigning the state control
They work to achieve the objectives of policy objectives set by the government.
· Health Reform Hoggervorst 2006: universal access to treatment more attractive to
«Private» (already in 2002 94% of Dutch hospitals were «private».)
· The State assumes the role of «regulator» but not «dispenser» of health services: the
management becomes «private», whereas an «authority» established system control
(«Supervisor of the markets.»)
· Central role of «doctor» as the prescription of health care costs.
· fundamental principles’:
? The basic compulsory insurance for all citizens older than 18 years
run by private companies an obligation to ensure that everyone, regardless of age
or the health of citizens.
? Competition among health insurers among the suppliers of services:
insured company may change each year and part of insurance
It is earnings-related component.
? The insured can choose between «direct» or «indirect» support.
Dutch model: «TRIANGLE»
Buy market
health action
Insurence Market
Insurence Market
Market supply
Italy is the only European country that has gone from a pre-existing «Bismarck model» to the
Current «Beveridge» is going through a transition that has led to a significant imbalance between
north and south, both for consultations on the quality of cost performance. Very
interesting in this respect a study fig. (6) conducted wing Bocconi (OASIS 2009 ratio)
documents how 2/3 of the amount of health care within the total deficit in three southern regions
(Lazio, Campania and Sicily).
Studi BOCCONI commodification of health care PERIOD OF ITALY
· Total deficit in 8 years: net flows of 32,190 euros
· Only the regions of Lazio, Campania and Sicily produce 21,900 million deficit equal to
2/3 of the total amount.
Picture 6: imbalance between north and south in the deficit of health: study of Bocconi.
Very interesting research decreased «Hospitals and Health» (photo 7,8,9 and 11) recently
published by Ermeneia and coordinated by Nadio Delai which it has documented, based on the
data provided by the Ministry of Health, health and more efficient mechanisms exist where
competition reached public-private, extolling the right choice of citizens based on quality,
but also on the timeliness of services.
Estimation and implicit public inefficiency in 15 Italian regions: Ermeneia force survey 2010
in the 2008 report (to the Ministry of Health and the regions)
or a. Hospital production of «correct» value:
· [Right] value for DRG (corrected according to «house mix» medium)
· Value benefit specialist
· Additional cost to work-function (emergency room, intensive care, regional offices
for drug addicts, transplant, cancer, ADI, etc.)
or b. Total of «real» costs (staff, equipment, purchases)
or c. Inefficiency absolute value (B-A)
or%. The inefficiency of the total costs (x 100 = C: B)
Ermeneia survey and Italian implicit public inefficiency.
Percentage of revenues / costs in public hospitals in Italy
Total reveues Region Difference inefficiency% of total costs
the total cost
Piedmont 2371.7 3231.7 -860 26.6
Lombardy 4313.0 5187.9 -874.9 16.9
Veneto 3162.1 3859.4 -697.3 18.1
Emilia Romagna 2994.1 3779.2 -785.1 20.8
Tuscan 1787.3 2299.5 -512.2 22.3
Umbria 635.0 790.4 -155.3 19.7
Lazio 2681.4 4707.2 2025.8 43.0
Campania 1847.4 3207.4 -1360.0 42.4
Apulia 1701.4 2239.7 -538.3 24.0
Calabria 776.4 1423.8 -647.4 45.5
Italy Mid 1730.3 2388.3 -653 27.4
Figure 8: Relationship sales / costs in Italian hospitals: A survey Ermeneia
Value of inefficiency in public hospitals
9: The values ​​of inefficiency in public hospitals: a study Ermeneia
This was especially the case of Lombardy, the Italian region where only a law was passed in 1997
(Photo 10) which places the public and private sectors on an equal footing, with the distinction of
hospital healthcare companies, public and private companies to non-hospital health care law as a
body to monitor the activities of public and private hospitals gathered in the competition. The
It resulted in the first 12 years of application is in the eyes of all inefficient hospitals were
closed and the most qualified to play a very significant amount of activity could Lombardy
we have the best public and private hospitals in the country with European standards, with peaks
excellence on the international stage
Lombardy Region Law 31- / 97
· Separation of local health authorities and hospitals
· Equality between the public and private operation
· The performance pay
· Cost control / efficiency of hospitals and private hospitals, placed on an equal footing
by ASL: remove «conflict of interest»
· Reaffirming the principles of universality and solidarity, however, strongly
reaffirm the right of freedom of choice (principle of subsidiarity)

How the other regions and the autonomous province of Trento with the progress of Europe
integration in the field of health and also with the implementation of federalism in our country?
What would purely speculative hypothesis, if the funding of health care was in Trentino
by an insurance system, within which an important role could be played by the world
cooperation, they could choose between public or private providers in relation to the acquisition
medical services, ensuring your health insurance? What are the advantages in terms of
limits for medical expenses in continuous expansion, especially in systems to public monopolies, and
quality and timeliness of services?
And yet, why not think of a model of financing and provision of health benefits and wellbeing
border situations in the framework of existing partnerships in other sectors or territories
Euroregion, the placement of a single uniform system and applied the principles established in the
European directive on after-sales service in the community?
I think these considerations can provide an opportunity for a political argument now
ineludubili if, in the light of the tragic economic situation of our continent, we want to maintain a
health care cost system stimulation quality that unfortunately are driving most of
public debt.
Carlo Stefenelli
Associazione Italiana Ospedalità Privata
Sezione della Provincia di Trento
Advisory OMth
Montecatini Terme (I) 21 hasta 22 October 2011
Omth undertakes to disseminate the opportunities for Devolopment of EUdepartment
the relationship between the thermal structures indicates the difference in order to promote innovation and
The «Leonardo Project» is a concrete operational tool, and we are very pleased that the annunce
Montecatini Terme (I) Leader Cuntis (Spain), Technirghid (Romania) he proposed and received a
funding for the «Project of Geriatrics and hot springs». The presentation and first meeting
place in Montecatini Terme (I) on 22-23 October 2011.
We are very pleased to welcome the speech «Mr. Antonio Galassi, Director thermal Montecatini (I)
and expressed the warmest congratulations participans all.
He has also successfully completed Saturday, 22 October, the first meeting in Montecatini for
Lifelong Learning Programme Leonardo da Vinci (2007-2013), edited and financed by the Europen
Community, on «Active Ageing Termas». For this work the Thermal Baths
Montecatini were winner and leader of applied research for the years 2011-2013.
Montecatini Terme Istituzional partners for the project are: sl Termas de Cuntis, Cuntis
(Spain) is the bathroom Sanatorium recover, Techirghiol (Romania), University of Pisa,
Department of Internal Medicine-Geriatric-section.
Leonardo Programm, provides stuy interventions and times of the thermal intercultural
structure, qualitative assessment and prevention in old age and aging problems in Eurpe contries.
This work is to validate the further development of cross-border mobility to cure 500
stadiness Europen million.
Project Manager for Italy is Professor Monzani University of Pisa (I), Mr. Galassi of Montecatini
Terme (I), and the program coordinator, Mr. Fausto Bonsignori Livorno (I).
On the first day of Friday, 21 decided to share with the partners involved in the
The planning work which has defined the stages of the project will be
divided into four phases:
The project is divided into 4 phases based on the temporal development:
FIRST PHASE OF HOME Montecatini Terme
SECOND Cuntis first implementation phase
First phase: Italy Montecatini Terme 21 a October 22, 2011
Second phase: Spain, 11-12 May 2012 Cuntis
Phase Three: Romania, Techirghiol 5 to October 6, 2012
Fourth stage: Italy, Pisa 10 to 11 May 2012
Main activities: Principal Actors
The partners need to work together in all activities. Choose a coordinator of the most important activities.
For example, we can list some names:
General Coordination of connection between partners Montecatini Terme
Guidelines and good pratice Techirghiol
Reports Montecatini Terme activities in video
Evalutation of the progress of all projects Cuntis
Sub-project of the University of Pisa
On the second day (Saturday October 22) were brought to the attention of those present (Doctot
Medical Thermal, school of specialization in geriatrics, General practitionrs), reports
the scientist in charge of the application:
Dr. Fausto Bonsignori, Project Coordinator, Prof. Fabio Monzani strategy and objectives,
Director of the Section of Geriatrics immersion. Internal Medicine, Univerity of Pisa, present and future
geritric medicine.
Prof. Gloria Raffaetà, physical and thermal rehabilitation of Pisa University, Prof. Olga Surdu,
Techirghiol santatotriul University of Konstanz, the psychology of the againg process and modulating
Thermal Paramates.
Prof. Rosa Martines, Cuntis Terme Spa in clinical Cuntis.
Dr. Antonio Galassi, chief medical officer of Montecatini Terme, experience with older patients.
Reports have promoted a frank discussion with medical assistance, as the leading expert
Cures the engineer Ennio Gori (President AITI) and (Omth), Prof. Antonio Fraioli (
University of Rome) Prof. Peter Pasquetti (Univesity of Florence) and Prof. Francesco Russo
The engineer of Gori, President Omth, expressed warm congratulation on the initiative can do
operational in scientific research, a real collaboration between the different thermal structures
E.U. nationalities »
This commitment is part of an attempt in that from October 2013 Directiv
rignts application of patients in cross-border healthcare Everybody Ntionals Community Facilities.
The thermal therapy can be freely made by Europens in another State without prior authorization,
on condition that they provide in their systematic healt. To achieve this momentous Omth
specifically committed itself to achieve a goal that is scored to a new spa at the beginning of the
Proffessors Fraioli, Russo and have accepted the validity Pasquetti expressed by the scientific work
partneers projects submitted by potential therapeutic activities and thermal mediumand
European environment for over 65 years with chronic diseases.
The day ended with a farewell to the next meeting in Cuntis (Spain 11-12 May 2012) and the
next Techirghio (Romania) in 5 to October 6, 2012
Dr. Antonio Galassi
Direttore Health
Terme di Montecatini.
Moroccan delegation in Trentino
During the Congress, «the new frontiers of the health of the European system of free movement
of patients in the States of the European Union between «public and private, held in Ohrid
24 September, has been the possibility of accommodation in the region of Trentino Alto Adige Spa and
competent Moroccan delegation.
The delegation consisted of: ing Project Director of the Agency Youres Jabrane South
Mounir Jbilou (Agence du Sud, Unité de Gestion du Pêche Ingénieur Principal Program,
Responsable de l ‘UGPP), by Eng. Saadia Bahaj Department of Energy and Mines.
The collaboration between Omth and Morocco came from the participation of President Enio Gori,
in Rabat on 21 May 2010, the panel focused on the development of health centers in southern
Morocco organized by the Agency for the promotion and economic and social development
Southern provinces of the Kingdom. The issue was one of the most challenging and innovative
Hydrotherapy has since been identified as a vehicle for growth of certain areas of the Sahara.
Lamssid The site chosen is located between the desert and the Atlantic Ocean, which is
become the place of the «baths of the desert».
The September 21-22-23 Omth organized for the delegation on a tour of the two largest and most
Qualified resorts Tyrol Trentino and spa. It was the occasion for a visit three spas whose
conceptions were definitely useful for conducting Lamssid station and more precisely:
Levico Terme, Terme di Comano and Therme Meran.
The heads of the three stations the delegation met with particular warmth giving an opportunity
to deepen both the technological aspect is the emergence of health practitioner with their views on
the type of waters and also in the various possible enter medical specialties
apart. The delegation also could delve into the different strategic aspects of the different
specialties are the three realities.
The visits and meetings with leaders of the three spas (dott. Paul Andreaus, Director General of the
baths Comano, the Dott.ssa. Tiziana Lalli Vico, Marketing & amp; Presses baths Meran;
Donatella Bommassar, President of Levico Terme-Vitriol) have allowed the delegation to introduce
He proposed an innovative water will be especially useful for concrete
Lamssid implementation as a benchmark for the entire region of North Africa. The
Delegation concluded by confirming the mission of the close relationship between omth and termalisamo of
III thermal Meeting OMTh Brasile 2011 – Water Lindøya / Sao Paolo 29 and November 30
This is what we welcome the news of an event of unquestionable importance in Aguas de Lindoia (s. Paolo-
Brazil). On 29 and 30 November 2011 it was held the 3rd Meeting organized by the Thermal OMTh
Brazilian society of hydrotherapy. It was a meeting of great scientific value that our honors
Organization and give proper emphasis in the next newsletter.

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