Table 1 The public health and screening organization in Region of Lombardy

National Healthcare System

Italian Minister of Health (IMH)

The parliament sets the Essential Levels of Care (LEA) and the National Health Fund. The IMH, with the support of the National Screening Monitoring Centre, agrees with regional governments the operational definition of the screening LEA, the monitoring of LEA-related indicators, objectives for implementation and quality assurance, and budget criteria for fund allocation (linked to objectives). The National Plan of Prevention, the national guidelines for screening and the screening reporting system are the main tools for this task.

Healthcare System of the Region of Lombardy

General directorate of Welfare of Region of Lombardy (DGW-LR) Prevention Unit

-defines budgets, rules, objectives for Local Health Authorities, which are the payers, and for hospital and clinic trusts (called Territorial Health Social Trusts), which are the providers;

- coordinates and supports Local Health Authorities;

- manages regional “monitoring system” (database) to guarantee oncologic screening to all citizens of the Region of Lombardy evaluating data reported by the LHAs;

-reports performance indicators to IMH.

8 Local Health Authorities

(LHA) – including 15screening centers

- make agreements with the Territorial Health Social Trusts and with the hospitals with regard to the number of medical exams of screenings (mammograms, fecal immunologic tests, colonoscopies, pap tests, etc)

- control the quality of medical exams

-report data to DGW-LR

- manage the “call-recall system” (send letters, recall, manage website, etc.)

-manage communications with patients (by e-mails, call center)

-elaborate performance and early outcome population-based indicators

- evaluate the performance of each hospital and refer the data of activities to DGW-LR.

public accredited hospitals (27) and private accredited hospitals

- do medical exams of screening, assessment and treatment

- report data to LHAs