Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Italy

Clinical Teams in ITALY

Bari Bologna (Ospedale Bellaria C.A. Pizzardi) Bologna (Policlinico S Orsola) Catania Ferrara Genova Milano (Instituti Clinici di Perfezionamento)

Milano (Regional Centre for Cleft Lip and Palate) Napoli Padova Parma (Azienda Ospedaliera) Parma (Ospedale Maggiore) Pavia Pisa (Ospedale di Cisanello)

Roma (Azienda Ospedaliera S. Camillo Forlanini) Roma (Instituto di Clinica Dermatologica) Roma (Ospedale Pediatrico Bambino Gesú) Rovigo Trieste Verona Vicenza

Population
Approximately 56.7 million.

Health Service
The health service is organised on three levels: national (Ministry of Health), regional (Assessorato alla Sanità) and local (Azienda Unità Sanitaria Locale). Currently the system is changing from one based on a single national health service to numerous regional health services. The Ministry of Health sets the three year planning goals of the national health service. Regional councils are responsible for co-ordinating health service operations in their area. The state delegates responsibility for establishing the areas under the control of the various different local health care units to the regional councils who must do so in consultation with the local bodies concerned.

The national health service is financed partly (40%) by government funds from taxation and partly (60%) by a health care contribution levied at the regional level. Each employer and employee must pay a set amount. Each employer, whether public or private must pay an additional sum for each of his/her employees and a surtax, called the health tax is also paid by independent workers. Funds are collected partly at the regional level and partly at the national level. The overall fund is distributed among the regions and then among the local health authorities. The criteria used for the allotment of funds are set by the government and are based on the resident population in each region. Recent legislation in 1993 expressly emphasises quality assurance programmes within health service establishments. Regions are responsible for monitoring these programmes.

Cleft Care Organisation
There are around 876* new cases of clefting per year in Italy and such patients are treated in around 20 locations. The organisation for cleft specialists, SILPS, has been in existence since 1995 and organises scientific meetings on specific topics. Some regional centres are emerging but more frequently care is provided by individual clinicians. A range of surgeons with different specialities and varying levels of experience carry out primary surgery.

Challenges to Attaining the Eurocleft Consensus Recommendations
There is no official government policy on cleft care at present and a general lack of financial support for cleft clinicians. There are no special training pathways although SILPS provide regular scientific meetings on cleft lip and palate. Professionals are not united in their thoughts on the strategy for the organisation of services and there is resistance to centralisation. There has been limited involvement of Italian centres in intercentre comparison studies and so far no participation in clinical trials.

Future Plans
There is an increasing awareness on the part of national government, local authorities and the general public about the treatment of cleft lip and palate due to publicity efforts. There is difficulty in changing the mindset of clinicians throughout the country from one of competition to collaboration, however some groups have started to participate in intercentre studies both on a national and international basis and it is hoped that this approach will continue. It is also envisaged that SILPS, the scientific association, will organise meetings where clinicians will have the opportunity to discuss the topic of the “cleft team” approach.

* Estimated number of clefts per annum using World Fact Book figures of 56.7 million population, birth rate of 9.27 per 1,000 population and assuming incidence of clefting at 1:600.