Research Political Sciences

Decentralizing Cancer Care Benefits People and the Environment

, by Valentina Gatti
A study by CERGAS has estimated the value of keeping care delivery points closer to communities, in economic and environmental terms

Mission 6 of the PNRR (National Recovery and Resilience Plan) envisages, among other things, the decentralization of healthcare to the territory, through community homes (one for every 50,000 patients) and community hospitals (one for every 100,000 patients). But to what extent is a territorial care model sustainable in environmental, social and economic terms?

Giovanni Fattore, Michela Bobini, Francesca Bobini, Francesca Meda, Benedetta Pongiglione, (all of them from CERGAS research center at Bocconi) Luca Baldino (Directorate General for People Care, Health and Welfare, Emilia-Romagna), Stefano Gandolfi, Manuela Proietto, Stefano Vecchia e Luigi Cavanna (Piacenza Health Authority) e Licia Confalonieri (Roche) shed light on the subject in their paper "Reducing the burden of travel and environmental impact through decentralization of cancer care", published in the February 2024 issue of Health Services Management Research.

The study, which considers a period between July 2016 and July 2021 and more than 18 thousand microdata on interventions, compares the care administered to cancer patients in hospital with the care provided at local level in the Bettola "Health House" to patients in the Val Nure, a remote valley in the Piacenza area. Thanks to the Health House, oncologists and nurses can visit patients in their own homes in the valley.

This model, implemented for all local supply points, guarantees a homogeneous approach to the management and continuity of care for all patients regardless of their place of residence: in fact, the same doctors who perform the services at the hospital also perform them locally. The quality of care is at the same level in the two different contexts also because they have parts of the treatment path in common and because chemotherapy is managed by the anti-blastic drugs unit in Piacenza.

Decentralization of cancer treatment is made possible by the increased safety and manageability of current cancer treatments, which do not necessarily require hospital facilities.

The retrospective study by Fattore and colleagues compares the care provided to cancer patients by the Piacenza hospital with that of the Bettola Health House. In the period between July 2016-July 2021 the decentralized health center provided 2,292 services, saving 218,566 km, estimated to be worth €131,140. The additional costs for the SSN (National Health System) were €26,152.

Research shows that the decentralization of care is environmentally sustainable due to the reduction of 32.37 tons of carbon dioxide emissions, worth almost €6,000. In addition, it has social value because it reduces the time and effort for vulnerable patients, and community homes provide a more pleasant and humane environment for patients, with an estimated benefit to them of €110,000. The paper also showed that being closer to the community also benefits doctors and nurses, who see it as a professional and human enrichment and as a break from hospital routine.

Ultimately, the economic benefits for patients are substantial and, from a public point of view, decentralization of cancer care saves costs. In a largely mountainous and hilly territory such as Italy's, with an elderly and geographically dispersed population, decentralization therefore provides an important opportunity for cancer patients.

Giovanni Fattore, Michela Bobini, Francesca Meda, Benedetta Pongiglione, Luca Baldino, Stefano Gandolfi, Licia Confalonieri, Manuela Proietto, Stefano Vecchia, and Luigi Cavanna, "Reducing the burden of travel and environmental impact through decentralization of cancer care", Health Services Management Research, published online 2 February 2024, DOI