continually reviewed? What is constantly changing? Why do public health systems tend towards privatization and not vice- versa? Why is an important profession such as health care more than any other at the centre of debates and controversies? Why is one of the most important services that every state should give priority to so different from country to country?
The evolution of society has gradually shifted its focus to the level of the hierarchy of needs, as has inevitably been the case also for one of the basic services organized for citizens in modern societies, "health protection".
Today, the close individual-environment connection is undeniable, seeing the correlations between environmental degradation and health risks. This awareness has been gradually triggering growing consciousness and the culture of prevention.
The environmental crisis, the crisis of health and the crisis of values are closely linked and interdependent. The system responds to the request for health with an increasing number of expensive and technologically sophisticated performances; trying to modify the natural history of "disease", which in itself already implies "lost healthâ. Neglecting, instead, primary prevention which is to be made both on the polluted and unhealthy environment around us, as well as on individuals, accompanied by an appropriate policy of information and health education in search of a more simple and sustainable lifestyle.
Ethical and social values are sometimes contrasted by economic value, hence the need to make the health system sustainable while ensuring conditions of equality and universality.
All countries in the world are committed to finding answers for the enhancement of its citizensâ health.
Various countries, principally the developed ones, have established health care management models essentially of two types: a predominantly public model named Beveridge after the Englishman who at the end of World War II brought public insurance coverage to the United Kingdom, the "National Health Service"; and the Bismarck model, which takes its name from the Prussian/German statesman who introduced the private health insurance system.
Different countries have tried, even with customizations, to adjust such organizational models to the ever-changing demand for health, in the variable environmental and economic contexts, in order to maximize their population's health.
In the 90âs, the World Health Organization altered the attention level of health protection systems, shifting attention from the treatment of diseases, to seeking the psychological well-being of individuals and the environmental determinants of health.
To organize health care, man began his fight against diseases that in the nineteenth century was focused on therapies against infectious diseases. Around 1850, the construction of the first pavilion hospitals began, which soon showed the potential of hosting and connecting specialized activities that were beginning to emerge. These were mostly surgical, as a result of the revolutionary scientific discoveries and practices of the birth era of the foundations for anesthesia, microbiology, antisepsis and asepsis, but also diagnostic laboratory support, followed by diagnostic radiology (X-ray, 1901 Nobel prize), to which electrocardiographic diagnostics7 would be added soon after (Einthoven, 1908).
In order to organize health care in addition to acute patient management and thus urgency/ emergency, you need an increasing ability to manage chronic illness through a holistic vision that includes active handling of the disease, more often chronic diseases to be centered on prevention.
In recent years the traditional and hierarchical health care model that is identified with hospital care has began to falter, not only due to the high cost of energy, technology and management but also because of the profound epidemiological changes in diseases. Traditionally, the cure of acute illnesses has reportedly developed a standby medicine in the top-down hospital context, a facility increasingly dedicated to users, emergency and to the treatment of high intensity and in need of advanced technologies. The hospital has become ineffective for the treatment of rising widespread chronic diseases in need of multidimensional interventions, also linked with social health.
The increase in life expectancy with the progressive ageing of the population has led to the augmentation of chronic degenerative and debilitating diseases, for which the traditional hospital standby model is inadequate.
The attempt to create within the hospital outpatient sectors for specialized external uses has proved unsuccessful for a number of reasons: the structural and hospital management costs are too high for such activities, and the type of performance is completely different since the acute patient must be treated in the hospital and the chronically ill should be treated in the zone, through the enhancement of organizational models characterized by prevention.
Merging the management of activities for acute disease with the management of the activities for chronic illness inside the hospital deviates high-tech and urgency resources from interventions for the acutely ill. The center of gravity of care for chronic conditions needs to be moved into the territory, with the need for increased effectiveness also through avoidance interventions. Prevention becomes the pillar of the distributive model of territorial health care: not only due to its undisputed importance in the promotion and maintenance of health, but also for the better utilization of resources, resulting in cost reduction. The new strategies for the integration of health policies must necessarily take into account environmental sustainability.
After a period of constant evolution and adaptation of the specific structure for increasingly accurate, effective, technically advanced and prognostically favorable treatments, - the hospital - the focus, has opened itself towards the territorial zone for several reasons.
The hospital is a highly sophisticated structure with high technological trends, high management costs only justifiable for performance-intensive care given to a patient in acute emergency and made possible only in a protected environment.
The territory consequently gains importance not only to provide care and treatment to low-intensity patients and to guarantee care continuity and the patient's recovery. But above all, to prevent and anticipate the disease (early detection!). In addition, the territory also represents an important input filter and selector for hospitalization.
The hospital, by vocation, treats (or should treat!) 100% of the acutely ill, while health outside the hospital treats (or should treat!) mainly the healthy to ensure a minimal occurrence of sickness.
The primary care target is therefore made up of 40% of healthy individuals, 40% of healthy individuals with risk factors and the remaining 20% of ill individuals (of which 10% have disabilities).
The hospital's mission is maximum repair and cure of the individual's biological damage, while the mission of the zone is to avoid health damage through multiple strategies on population health, even informing and educating people of the best way to live .
In a distributed model of medicine of the territory, health professionals and family physicians are the central figures in order to achieve a proactive medicine. Proactive medicine is centered on the promotion of good health and the prevention of bad health. The health of a community is determined by socioeconomic and environmental factors, lifestyle and access to services. It is evident that only the model of distributed medicine in the territory with a central role in prevention can ensure the implementation of a wide range of initiatives, projects and policies necessary for effective health promotion.
Hence, the necessity emerges for an integrated strategy between governmental bodies and non-governmental bodies, in the possible fields for regional action. From the action of doctors on the territory and in schools, to interventions by the public authorities through training activities based on epidemiological evidence. The concept of integration is essential and must be developed in a distributed model of Zero Zone, cornerstones of which is home medicine and telemedicine: i.e. trying to
