Costs and quality in loco-regional anesthesia.

Quality can be considered to be a strategic element in the political process of planning and implementation of health and social care, resulting in a form of guarantee for the public through encouraging constructive competition between providers and reducing wasting and poor management. This should also be applied to managing loco-regional anesthesia. Competition is constant between treatments currently available together with a focus on quality and costs. This brings about strict controls on health care costs which should then be based on the evaluation of the results obtained in terms of health. It is obvious that costs for materials, time spent for an intervention, staff employed and structures required to carry it out are unavoidable. Quality is that treatment which maximises the patient's well-being following evaluation of the expected risks and benefits involved in the overall treatment. Acute pain is suffered by surgical patients either due to pre-existing disease, surgical intervention or due to a combination of both these situations. There is a high incidence of postoperative pain. In fact, more than 75% of postoperative patients report to have suffered moderate to severe pain. The same results have been reported in pediatrics and oncology: these results should always encourage the application of clinical quality, taking into consideration the costs involved when carrying out loco-regional anesthesia which aims at improving patient's outcome when undergoing surgical intervention.

[Clinical pathways and case management in anesthesiology]. / Le Clinical Pathways ed il Case Management in anestesiologia.

Clinical Pathways and the Case Management represent clinical and management tools for organizing patient care. These tools focus on results and use a multi-disciplinary approach, with the goal of providing high quality, cost effective care. Both systems require the care providers to interact with the institution or the health care network. As health care is part of a refund system, the specialist must cooperate with personnel of other disciplines as a member of a team which works together to improve the quality of health care, while containing the costs. The Clinical Pathways and the Case Management are two tools for achieving these goals. The most important limit of a cost control system is the division split of health care into single components instead of considering the entire diagnostic course. Without doubt, the Disease Management appears to be the most effective control system of health care costs now available.