An aspect that denotes the SSN is unfortunately the exorbitant costs that it generates and the huge resources financial institutions that absorb.
From years the political leaderships agree, even if with different positions, on the fact that urge participations finalize to you to restructure such field in strong loss.
Currently the lines guide supplied in order to reduce national sanitary expenses are: responsabilizzare of the regions entrusting they it direction and management of the respective USL; to put into effect economies of scale centralizing not only the management, but also the structures hospitals worker.
In the specific one a process of reconversion of the hospitals of smallest dimension is being put into effect, that is those with less than 120 places read that they constitute still nearly 1/3 of the total.
In effects regarding the greater communitarian countries, our structures hospitals worker strongly turn out under dimensions: as soon as 30% of the same ones have a advanced equipment of places read to the 500 units and many hospitals to direct management do not catch up neanche the 100 places read.
In order to catch up economies of scale one previews instead the centralization of the warehouses hospitals worker. In practical tip $R-alla.chiusura of the warehouses of a district hospital worker letting some active one only that it will have to supply to the refueling of all the units of all the hospitals.
The objective is that one to carry out a total organizational rearrangement of the service in the insertion perspective, in the process of supplying and distribution of the druggist productive factors of a " external subject" to the company which activity series will be remitted one.
Such rearrangement will invest, as well as the aspects operated to you how much those informed to us correlates you to the various activities, and will determine substantial modifications also in the relationships with the "inner customers" who will have unavoidablly to adapt themselves to the change.
To here of the specific appraisals on the various activities that will have to be put in field for the performance of the plan, it is necessary to place the attention on some elements of the same one that of it represent the primary objective; that is those economic appraisals that determine one assumed realization of meant savings to you.
The document " Rationalization of the functions acquires and logistics Business Plan " (elaborated from the Accentare and whose they give to you they turn out recepiti from part of the Tuscany Region in the within of the plan of rationalization of the logistics) previews between the other things an operation of centralization/exsternalizzation of the pharmacy warehouses adducing one hypothesis of savings: to regimen of the entire process of centralization/exsternalizzation (year a 2006) reduction of costs of approximately 5.200.000 of euro the year had to the management in outsourcing and previews the estimative contract application and the zero setting of the lyings of property of the sanitary companies.
23 units) e mployee from the SSR remain a operating costs of the personal druggist (, indicated like staff of the companies dedicated to the logistics, the indicated cost of outsourcing equal is to 3.1% of the value journeyed to constant warehouse and considered from 2004 to 2007. Modifications in the consumptions are not previewed; the economies on the costs derive from the discouragement of the costs on the staff and from the zero setting of the supplyes of property of the Companies , from the strong reduction of the other operating costs (rents, users, etc), from the cancellation of the financial burdens for immobilization of the supplyes.
The costs put into effect them of management of the pharmacy warehouses have been estimated, in the same document, par to 4,6 % of the journeyed value (comprised the financial burdens for immobilization of the supplyes). No hypothesis has been made previewing a various organization of the logistics, putting into effect plans of rationalization of the pharmacy warehouses, optimizing the resources puts into effect them and previewing a management equipped with spaces, but above all average, technologies adapt and adapted training to you of the attached staff. Main aspects to carefully estimate (points of critical) in the model assumed in the Business Plan (Accenture) are:

1. Real costs in the course of the time of the management of outsourcing regarding the costs of the warehouses put into effect them (the percentage even if fixed it is tied to the value of the journeyed material), above all for those beyond the plan previewed (beyond 2006).
2. The cetralized management in outsourcing could carry verosimilmente to a monopoly that would reduce in the time the competitiveness on the market of possible outsourcer and the demand in the time of costs increases you for the management of the service (is determining the type of stipulated contract).
3. The esternalizzazione process would carry to "sterilizing" the organizations that currently manage the products dì competence of the Pharmacy, the process assumes many characteristics of event to only sense.
4. The tempistica of the deliveries and urgencies are aspects of great relief and responsibility; every change must carry to one just calibration of these aspects.
5. It is not thinkable that all the products are manage in exsternalizzation, above all as far as Hospitals or activity to high specialization. In kind that that is distributed to stock re-enters mostly between 80% of the fermaci that they generate 20% of the costs. The innovative therapies, the technological acquisitions, that they represent in remaining kind the responsible voices of the relative expense to 80%, however would be prescribed with personalized prescriptions, which participation dedicated to patient and eventually monitorations, therefore difficultly gestibili in regimen of exsternalizzation.
6. All the suppliers are not available to accept this type of contract as an example (drug producers also in exclusive right, but whose supplies contained for are quantitati you of consumption does not elevate to you).
7. To hold account of the resorption of the professional and operating figures currently dedicated to the warehouses. In an optical which that one introduced the effective discouragement of the costs for the SSR is put into effect alone with the numerical reduction of the staff (lacked turn-over).
8. To hold account of the possible increase of the supplyes near the user (units).
9. The drugs have various implications respect to other consumer goodses, the responsibility of the druggist are restricted from norms.
10. The plan does not point out which level of improvement of the appropriatness on the use of the drug and the garrisons (discouragement of wastes and of the uses it does not base to you on the evidence) must take part the process of rationalization of the druggist product management. They are the participations, above all of cultural type, that they can determine a possible one, control of the consumptions (and therefore of the costs) naturally to parity of performances; such participations essentially consist in promuovere/valutare the appropriatness of the prescription and the application of the therapeutic protocols you flavored yourself. Also in the case of the devices you doctors and the medication materials, the best savings can be achieve themselves through participations orient you to one more careful appraisal - also on the economic plan - of the therapeutic choices, above all in relation to the insertion of new acquisitions ³⁵ .

• Note 35: SiNaFO Source