ABSTRACT
OBJECTIVES: Italian regional health authorities annually negotiate the number of residency grants to be financed by the National government and the number and mix of supplementary grants to be funded by the regional budget. This study provides regional decision-makers with a requirement model to forecast the future demand of specialists at the regional level. METHODS: We have developed a system dynamics (SD) model that projects the evolution of the supply of medical specialists and three demand scenarios across the planning horizon (2030). Demand scenarios account for different drivers: demography, service utilization rates (ambulatory care and hospital discharges) and hospital beds. Based on the SD outputs (occupational and training gaps), a mixed integer programming (MIP) model computes potentially effective assignments of medical specialization grants for each year of the projection. RESULTS: To simulate the allocation of grants, we have compared how regional and national grants can be managed in order to reduce future gaps with respect to current training patterns. The allocation of 25 supplementary grants per year does not appear as effective in reducing expected occupational gaps as the re-modulation of all regional training vacancies.
Subject(s)
Financing, Government , Health Services Needs and Demand , Internship and Residency , Physicians/supply & distribution , Regional Health Planning , Specialization , Training Support , Forecasting , Humans , Internship and Residency/economics , Italy , Models, TheoreticalABSTRACT
Ageing is doubtless a factor characterizing population in Europe, and particularly in Emilia-Romagna, a north-east Italian region of about 4,5 million people. From 1990 to 2010 life expectancy in Emilia-Romagna has grown by about 6 years for men and 5 for women. At the same time good health life expectancy has grown even more rapidly, particularly among women. While it is expected that in 2030 the number of over-65s will have exceeded one million people, the trends in good health life expectancy is not granted. Strengthen actions aimed at increasing good health conditions promotes ageing sustainability and can feed the positive trend observed for the life expectancy in good health. The Emilia-Romagna Region takes up the demographic challenge of the coming years in the European context and promotes strategies for active and healthy ageing, working on prevention in its broadest sense and for the entire life span, with the aim of actively contribute to the achievement of the EU2020 target of an increase of two years in life expectancy in good health of European citizens.
