The regional primary care agreements: tools for real demand control?

The analysis performed offers some useful indications for comparing the different regional policies for demand control geared to strengthening of the role of primary care and can, furthermore, contribute to ascertaining whether and to what extent the new organization of primary care in Italy can be an effective and appropriate tool for supporting direction and selection of people’s needs. From the analysis, what undoubtedly emerges is a first positive attempt to switch from objectives designed to ration demand to a real desire to meet patients' needs, thus creating a new role for primary care as the guarantor of appropriate use of the Regional Health System resources. At national and local level, there is less emphasis on expenditure ceilings and/or limits to deliverable equipment and services and greater attention to the planning of diagnostic-therapeutic paths. However, we are still a long way from achieving the objective of real promotion and assessment of health outcomes, i.e. of the real effectiveness of the policies adopted. With regard to the methods of incentivation for GPs who contribute to achievement of the objectives, extension of the variable service quality component is positive, but organiza- tion in three control levels (national, regional and local health authority) can be very complex (and therefore weaken the effectiveness of the incentives), due both to the presence of numerous objectives to be pursued simultaneously and because the part of the variable component allocated to pursuing objectives at decentralized level (where it is easier to measure and control the results) is still relatively low and it does not yet represent a real result-based payment.