The autonomous Province of Bozen has according to the Autonomy Statute primary powers in regard to public welfare but only secondary powers in regard to hygiene and health. In both sectors the legislative and administrative arrangements are a model at least for Italy.
Health: Public health care is exercised through a general service (general practitioners general paediatricians advice centres home care etc.) and a hospital service organized into four health boards: centre and south [Bozen and the Unterland (Bolzano and Bassa Atesina)] west [Meran (Merano) and Vinschgau (Val Venosta)] north [Eisacktal (Media e Bassa Val d' Isarco) and Wipptal (Alta Val d' Isarco)] and east [Pustertal (Val Pusteria)]. In order to make the general service more efficient and closer to the citizen the health boards have been divided into 20 precincts which are in the process of being set up and expanded. Each precinct contains apart from the towns not more than 20 000 and not less than 5 000 persons. The hospital service is divided into public hospitals private clinics which have signed a contract with a health board and private clinics which have not signed such a contract.
The eight public hospitals Bozen (Bolzano) Meran (Merano) L. Böhler-Meran (L. Böhler-Merano) Schlanders (Silandro) Brixen (Bressanone) Sterzing (Vipiteno) Bruneck (Brunico) and Innichen (San Candido) which in the 1970s and 1980s were rebuilt extended renovated and generously provided with technical equipment mostly by the Province contain about 2 268 beds. There are seven private clinics and three nursing homes with a total of 559 beds.
In 1993 the average length of stay in the public hospitals was 7.4 days while in the private clinics with a contract with a health board it was 28.7 days and in private clinics with no such contract it was 16 days. The bed-occupancy rate was about 77 per cent. In the above- mentioned year the public and private hospitals treated 92 712 patients who spent a total of 796 330 days in them. In addition in 1993 3 615 persons resident in South Tyrol were treated in hospitals in Austria. At the beginning of 1995 5 708 persons were directly employed by the health service (medical and non-medical staff technicians administrators); established posts amount to 7 332.
The operation of the Provincial health service which until 1989 was entirely financed by its own sources of income and the state's public health funds costed 392 billion lire in 1987 rising in following years to 462 billion in 1989 503 billion in 1989 611 billion in 1990 691 billion in 1991 768 billion in 1992 while 787 billion lire was spent in 1993. In addition the Province provides the resident population with other services for example in the fields of dentistry and home care (amounting in 1994 to about 42 billion lire) as well as bearing the costs for hospital building (140 billion lire in 1992 139 billion lire in 1993 and 83 billion lire in 1994) and medical procurement (27 billion lire in 1994).
The most important legislative instrument for the further development of health care in South Tyrol is the Provincial health plan. The main object is to tighten up the whole health service and co-ordinate it better through the setting up of the districts which have to provide basic care and through the grading of the hospital service according to needs. With the reorganisation of the social services the powers relating to their management were transferred to the eight districts. Only a few social facilities are still directly managed by the Provincial administration.
Pensions and accompanying benefits (a total of 12 571 payments) for 9 734 blind deaf-and-dumb and civilian invalids) and payments for supplementary care (12 054 net payments in 1994) are directly paid out by the Provincial administration. The Department of Social Affairs with its four offices has received more co-ordination planning financing and control functions. In the same way it deals with the further training of social services staff. It is the responsibility of the districts to manage all services for all citizens and for all problems areas. With the reorganisation of the social services a single organic service network was set up. The central plank is the division into precincts (congruent with those in the health service).
In each precinct there are four different services which all citizens can take advantage of: general social welfare public assistance child welfare and the home care service. Payments related to the minimum income and other financial payments are administered by the service for public assistance. Beneficiaries are those whose income does not reach the minimum or are in special need. At the present time (May 1995) 3 127 families with 6 074 persons are benefitting from this service. Beneficiaries of the home care service total 2 569 persons. In 1994 1 229 young persons were helped by the general social welfare services with 193 put into full-time and 189 into part-time care with foster families and 232 put into residential homes.
In addition the extensive measures for care of the physically and mentally handicapped (27 workshops for the handicapped and 445 persons being looked after 17 residential homes with 91 inmates) are also ensured by the districts. Care of the elderly is also supported by the Province. Beneficiaries of the various services for the elderly are 29 319 persons (2 675 in the 60 old peoples homes and nursing homes 3 640 in day centres 23 004 in clubs for the elderly). In South Tyrol there is sheltered accommodation for 353. In the two institutions directly managed by the Province the Provincial Home for small children and the Care Hostel there are 79 persons (minors and adults).