Planning home care services: which data do we need?

In Italy, as is true throughout the developed world, care in the home is becoming central to the delivery of almost all health care services to much of the population, especially those who are elderly. Although there are many reasons why this is true, including the dramatic changes in the demographic characteristics of the population being served, financial considerations are surely the proximate and most visible cause. As Diagnostic Related Groupings (DRG) are introduced with a fixed payment for acute institutional care for a given condition, regardless of the duration of stay, hospitals will increasingly have an incentive to shorten the period of hospital care. This will necessitate the provision of much care, previously provided on an in-hospital basis, to be delivered in the home setting. These changes in the site of care will demand considerations about the education of all types of professionals but especially physicians who traditionally have had little direct involvement in care in the home. In addition, there will be a requirement for an expansion in health care research so that comparisons of services and sites can be carried out with an eye to determining the most cost-effective way to provide for care. Lastly, epidemiologic studies will be needed to address the risk factors of those chronic diseases so frequently a cause of functional impairment requiring home care services.