Technical-economic management models in dialytic treatment: an evolving reality. The Italian experience

Health care organisations and financial factors (particularly treatment rei mbursement rates) may influence the management of ESRD. We analysed the org anisation of renal replacement therapy (RRT) in Italy, focusing on RRT popu lation trends, patient distribution by treatment modality and provision, re imbursement rates, accreditation and quality control. Data from the Italian Dialysis and Transplant Registry and market research studies indicate that Italy has one of the highest dialysis and treatment acceptance rates in Eu rope. There is a high rate of hemodialysis (HD) and good use of peritoneal dialysis (PD), whereas the prevalence of transplanted patients is lower tha n the European mean. Dialytic treatment in private centers is limited by la w to HD (mainly in Central-Southern Italy) and covers nearly 25-30% of the demand for RRT which means that, although Italy has a public national healt h care system, the provision of RRT is based on a "mixed" model. Regions wi th a higher prevalence of "private" dialysis have more dialysis centers, bu t a lower prevalence of PD since it is not permitted in private facilities, and fewer transplanted patients. The "public" system is not an automatic g uarantee of quality and efficacy, and the "private" system is not necessari ly a synonym of poor quality treatment due to its need to make a profit. Th e coexistence of private and public facilities (if well balanced and integr ated) may in fact help overcoming bureaucracy in the public administration in relation to the demand for innovation and improving performances by mean s of fair competition.