Azienda Sanitaria Locale di Brescia

The Italian National Health Service (NHS) is organised on three levels, national, regional, and local.

• The central body of the National Health Service is the Ministry of Health, which coordinates the services covering human health, occupational health and safety, and food hygiene and safety. The State is responsible for determining the essential levels of the health services that have to be guaranteed all over the country and for the international prevention and control of infectious diseases. In other words, the role of the State with regard to health is to guarantee equality in implementing the health rights established in art. 32 of the Constitution. The Ministry operates in a devolutionary context, having the authority to pass laws concurrently with the Regions, and it has regulatory authority toward the Regions with regard to safeguarding health, and to occupational health and safety, regulation of the professions, nutrition and scientific research. Agreements between the State and the Regions establish the financial resources for a three-year period and the essential levels of care, namely the services that the NHS must provide to the whole population, free of charge or with a partial contribution towards the cost.
• According to national laws and general indications of the Ministry of Health, each of the 20 Italian regions plays an autonomous and fundamental role in organising the health services in its area as regards health education and promotion and disease prevention and care. The Lombardy Region has developed a health service that guarantees care for all native and foreign residents through a wide range of services including general and paediatric care, hospital and health centre treatment, home care and pharmaceuticals.
  • independent choice of the hospital by the person concerned;
  • differentiation of the roles between hospitals and Local Health Units (Aziende Sanitarie Locali, ASL). The hospitals provide all clinical care within its setting, including day-care medicine and surgery and ambulatory services. The ASL is responsible for the health status of the population living in the area. Its job is to investigate the population's health needs and the weight of the most common risk factors for acute and chronic diseases in the area, to plan the health services required to respond to the population's health demands, to pay the hospitals and other local authorities for the services they provide, and to evaluate the effectiveness, safety and cost-benefit ratios of the health services provided according to standards of quality;
  • full equality of rights and duties for public and accredited private establishments, which must possess specific structural, technical and organisational requisites;
  • the introduction of mechanisms for the control of the quality system;
  • recognition of the role the General Practitioners play as the cornerstone of the NHS in the Lombardy Region;
  • improvement of prevention activities to ensure the maintenance and improvement of health and safety at work and in everyday life.
• The Local Health Units (ASL) are bodies with public juridical status that operate autonomously with regard to organisation, administration, management of assets, accounts, management and technology. Medical care and services are provided within its own area by public or accredited private hospitals and health centres. They operate in accordance with the criteria of efficiency, effectiveness and economy, and are required to balance the accounts. The Health Unit encompasses central and territorial facilities. The former includes some Departments, which have to establish plans and schedules, distribute resources and promote activities in the various areas of competence:
  • prevention
  • veterinary medicine
  • health service
  • addictions
  The ASL territorial facilities are organized in Human Health and Veterinary Districts. The Human Health Districts provide the following services:
  • health education
  • information and advice to help residents make informed choices
  • primary health care
  • home health care
  • health certificates
  • prevention and control of infectious diseases
  • hygiene in confined environments
  • food hygiene
  • protection of mother's and child's health
  • assessment of interventions for the disabled.
  The Veterinary Districts provide the following services:
  • animal health
  • safety of food of animal origin and animal products

The Brescia province's Local Health Unit is one of the largest in Italy. Below are some of the main end-of-year figures for 2005:

surface area	3,460.5 sq. km
population (2004)	1,070,896
birth rate (2004)	10.9 per 1,000 inhabitants
old people (aged 65 and over): % of the total population	males: 13% ; females: 20%
old age index (2003) (people aged 65+ / people aged 0-14)*100	140%
elderly dependence index (people aged 65+ / people aged 15-64)*100	30%
registered immigrants	12.5% (vs a national average of 5.2%)
towns	164 (the main town is Brescia, with about 195,000 inhabitants)
health districts	12
veterinary districts	6
ASL employees	1,733
2006 budget	1,391,475,000 euro
general practitioners	704
paediatricians	113
pharmacies	269
ordinary hospital beds	5,908
hospital beds / population index	5.74 per 1,000 inhabitants
residential nursing home beds	6,003
recipients of home care	11,846