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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

The growth and composition of primary and community-based care services. Metrics and evidence from the Italian National Health Service

BMC Health Services Research > Ausgabe 1/2012
Francesco Longo, Domenico Salvatore, Stefano Tasselli
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-393) contains supplementary material, which is available to authorized users.
Francesco Longo, Domenico Salvatore and Stefano Tasselli contributed equally to this work.

Competing interests

This FIASO collaborative research is supported by an unrestricted grant from Roche S.PA. Italia.

Authors’ contribution

Authors' names are listed in alphabetical order. All authors equally contributed to the paper. All authors read and approved the final manuscript.



Over the past few decades, in OECD countries there has been a general growing trend in the prevalence of out-of-hospital healthcare services, but there is a general lack of data on the use of these services.


We defined a list of 303 indicators related to primary and community healthcare services in collaboration with 13 Italian Local Health Authorities (LHAs). Then, for each LHA, we collected and analyzed these indicators for two different years (2003 and 2007).


Out-of-hospital care absorbs 56% of all costs in our sample of LHAs. Expenditure on outpatients’ visits to specialists and on diagnostic examinations accounts for 13% of the costs, while spending on primary care (including prevention and public health) accounts for 9%, and for intermediate structures (including those related to rehabilitation, elderly people, disabled people, and mental health) the figure is 11%. Different Italian LHAs have made different strategic choices with respect to primary and community-based care (PCC).


Two distinct strategic orientations in the adoption of PCC services by LHAs has emerged from our study. The first has been an investment mainly in ambulatory and home-based primary care services in order to increase the number of low-complexity settings. A second strategy has prioritized the allocation of resources to intermediate inpatient structures for specific types of patients, namely elderly and disabled people, post-acute patients in need of rehabilitation and long-term care, and patients in hospices.
Additional file 1: Appendix 1 the analytical data of costs and activities collected within the 13 LHAs (2007 data). Appendix 2 the criteria used to weight the inhabitants’ consumption of outpatient visits to specialists and examinations, pharmaceuticals, and hospital admissions, based on age and sex. (DOC 212 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
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