Atti del 52° Congresso Nazionale: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI)

The Italian National Health System presents several critical issues such as the complex patients' needs, the overlapping healthcare offer, the frequent recourse to hospitalization, the difficult choice between proximity or high volumes structures, the efficiency improvement and the remuneration methods 1 . The harmonization of patients' pathways is one of the aims of the National Health Service and takes place in two different ways: overcoming the fragmentation of the care pathway, by promoting functional operative integration between health and social care providers, and the availability of solid organization and technology for managing chronic conditions, according to the "population health management approach". In particular, the new organizational models tend to overcome the healthcare fragmentation, uniformly applying evidence-based pathways and system governance. The Liguria Region's response to the constant increase in health needs, which depends from the demographic and epidemiological characteristics of the Ligurian population (the oldest European administrative region), and to the critical issues related to system sustainability resulted in a substantial social and health reform based on the principles of equity, effectiveness, appropriateness and efficiency of health services 2 . These objectives can be achieved by improving efficiency and efficiency that can only be obtained by implementing a solid governance. A.Li.Sa., the new Liguria Health Authority, has the mandate to improve efficiency of Local Health Agencies, as well as for other regional Authorities, through governance and healthcare. It therefore, assumes a strategic role for the management of the accredited public and private healthcare offer, centralizing on itself the moment of health needs and demand assessment, the programming function and performance monitoring 3 . A.Li.Sa., starting from the analysis of health needs and demand, guarantees an appropriate and adequate provision of the essential levels of care and the efficient use of resources, also through the development of models of taking charge of the person throughout the network of health and social-health providers. In particular, regarding the function of governing the offer, A.Li.Sa. supervises and regulates the authorization, accreditation and negotiation processes, the agreements and the contracts with the departments responsible for providing the health services. Furthermore, the reform of the Regional Social and Health System foresee among its instruments of clinical governance for the integration and standardization processes, the improvement of quality, the efficiency of activities and the appropriateness of services, the establishment of regional inter-company departments (D.I.A.R.). 6 D.I.A.R. were created: Emergency; Cardiovascular; Neuroscience; Oncohematologic; Surgery; Transfusion, Laboratories, Clinical Diagnostics and Imaging and the D.I.A.R. Paediatrics is in phase of constitution 4 . The process of strengthening horizontal structures does not end with the creation of D.I.A.R., but requires a series of interventions supporting pathology networks. Liguria is among the first regions that formed and institutionalized Breast Units, organizational centres specialized in the prevention, diagnosis and care of breast tumour with an approached based on the "disease management" aimed at improving clinical and quality of health services as recommended by the European Surgery legislation 5 . Specif