The party programs on health care seem like a science fiction story

by Diego Foschi

What is striking in the current framework is the lack of debate, the absence of requests from the voters (the Scientific Societies are doing their part) and answers from those who will lead the state tomorrow.



In such a difficult moment in our national life, caught between the announcements of an inflationary economic crisis, the echoes of a real and a commercial war, not yet completely out of the pandemic emergency, we ask ourselves about our future and how to deal with it. the problems that most afflict us. For us surgeons, the degradation of the National Health Service has a central place. The crisis of our “Welfare” has distant origins, in years of economic downsizing and neglect that have had devastating effects. The Pandemic acted as an indicator, revealing all the inconsistencies and the unpreparedness of an administrative and managerial system of political appointment, but serious mistakes were also made by the heads of Health. To date, 176,000 dead, 22 million sick, 140 million vaccinations, the need to resort to the Army which in this difficult circumstance has greatly contributed to the salvation of the country, the long period of national curfew implemented to ease the pressure on the hospitals, they show us that the recovery of health care is a priority need.

In recent months, as an Italian College of Surgeons, within the “Forum of the Scientific Societies of Italian Hospital and University Clinics” (FoSSC), we have advanced concrete proposals to the ministerial authorities to start a path that gives certainty of treatment to those who are ill. As surgeons we know that the decrease in resources caused by COVID has led to a crisis in emergency and first aid services, to an accumulation of operations not performed to be disposed of, to an incredible lengthening of waiting lists for both diagnostic and for surgical interventions, including in the oncology field.

The causes are many and complex: lack of consideration for the medical and welfare profession, reduction of resources, programming errors in the training of doctors and specialists, lack of or poor personal, medico-legal and insurance protection, rules and laws that the system’s security burdens, low salaries, high contribution taxes, lack of transparency and clarity in fully informing users, pour on the professional. On all these issues we have provided clarifications and put forward concrete proposals, but in the last three years practically nothing has been done to remedy this. The ministerial narrative says that the health supply has increased by ten billion, but is silent that more than twice as much has been spent on the COVID crisis alone and this means that net of this the appropriation has decreased. As for doctors and specialists, it is true that enrollment has been expanded but it is also true that it takes six years to become a doctor and another five (generally) to become a specialist and in the next period retirements and escapes will increase. abroad.

Why does a doctor, whose training cost an enormous amount of public money, go abroad? Because he is paid much better, works with greater satisfaction, and runs far fewer personal risks (how many health care subjects of violence in the PS !!!), legal (only in Italy the doctor is a criminal until proven otherwise) and insurance (the dispute of gross negligence is a meteorite that can hit you at any moment). We asked that doctors be relieved of bureaucratic and administrative obligations, because support staff are easily found and cheaper, while doctors are not and will not be there. Every minute taken away from treatment is a lost minute. Give more space to female doctors, who are helped to devote themselves to their families and hindered in their clinical activity. We asked that doctors be definitively relieved of the medico-legal yoke, fully protected by the structures they belong to in the insurance field … but it has not happened and nothing will happen. We asked for the clinical results achieved by the different hospitals to be made public so that people can choose where to go without taking risks and rewarding merit. The data are processed annually by AGENAS and making them public is only a matter of transparency and will… Who knows when?

And in addition to doctors, there is also a lack of facilities. The availability of beds per number of inhabitants ranks 23rd in Europe and the capacity to use them is totally insufficient. The hospitals have been merged, the wards and diagnostic services have been reduced and weakened. All this could have made sense by increasing the efficiency of the system, but the exact opposite has happened and a great disservice has been created for a small saving.

During the period of the pandemic, all the parties declared that they would enhance health care but nothing significant has happened in these three years. Now we finally have the PNRR project which is a financing package calibrated on the basis of the Brussels provisions, dropped on our reality without any verification. We will have a healthcare investment based on two major items: construction and technology. However, the projects will concern community hospitals and community homes, territorial medicine structures, and large diagnostic and treatment equipment (mainly radiological). But building walls doesn’t mean having hospitals, which need staff and skills that aren’t there. And is it really more useful to renew x-ray equipment when our operating theaters fall apart?

We thought we would find the answer to these questions in the proposals of the parties and instead we are faced with generic and elusive programs. It is nice to think that politics gives up on managing competitions in hospitals, but it has not happened in the last 70 years and it is unlikely to happen in the next 70. Of course, regional health policies have different efficiency from Region to Region, but really the solution is it in abolishing regional health care or in differentiating the hierarchical relationship between center and periphery? Abolish the limited number of Medicine in the first year? It would only be possible by increasing the number of dedicated classrooms and chairs by ten, essentially increasing the duration of the pre-graduate study course since the real degree course would start from the second year. And how will it be possible to bring health financing back to a European level, perhaps by reducing taxes? But which Europe: Germany with 4,500 euros per capita or Malta which with 2,889 (2020 data) still spends more than us? Clear waiting lists by 2027? Relatively ambitious program, but if I get sick tomorrow… What do I do?

What is striking in the current framework is the lack of debate, the absence of requests from the voters (the Scientific Societies are doing their part) and answers from those who will lead the state tomorrow.

The health care programs of our parties seem like a science fiction tale, full of dreams and good intentions for a dystopian future, but the reality is something else: diseases exist and must be treated … now and here.

Prof. Diego FoschiPresident of the Italian College of Surgeons

See previous interventions: COGNTI

September 13, 2022
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The party programs on health care seem like a science fiction story

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