2023-11-11 10:52:29
Patients left without a family doctor; visits and tests carried out for a fee due to the long waits within the National Health Service which is unable to guarantee services in the right time, not even urgent ones, reported by the doctor, with the priority code, on the NHS prescription (see also The National waiting list governance plan 2019-21). And again: “dissatisfied” patients in the emergency room, others who had difficulty accessing integrated home care, often guaranteed only by nurses. These are some of the results of the survey promoted by Corriere Salute, together with the non-profit association Peripato, illustrated and discussed at «Tempo della Salute», underway in Milan at the Museum of Science and Technology, during a meeting entitled « Italians and the National Health Service – The results of a time.news investigation”, with the Minister of Health Orazio Schillaci and Sergio Harari, president of the Peripato Association, as well as professor of Internal Medicine at the University of Milan and head of Medicine internal medicine and pneumology at the San Giuseppe Irccs Multimedica Hospital in Milan.
The Minister’s comment
Minister Schillaci commented: «The data serve to understand the perception that citizens have of the National Health Service, and the survey highlights some already known strengths and weaknesses, for example, the majority of citizens are satisfied with hospitalization ; vice versa, the feeling one has of the emergency room is different: the problem is due to the fact that in many areas of the country it remains the only facility that citizens can turn to.”
The focus is on territorial assistance thanks to Pnrr funds
Certainly, the minister continued, «we need to ensure that fewer citizens go to the emergency room: from the data in our possession it appears that many people who go there should not go there (because there are no emergencies ed.); this is why we are increasing local medicine, which demonstrated its greatest weaknesses during the pandemic period; it is clear that a modern medicine closer to the needs of the citizen cannot ignore, in addition to hospitals that function well, territorial medicine which must be implemented by the role of the general practitioner, the one who knows his patients better than others and should direct them towards the most effective diagnostic-therapeutic pathways”. And again, said the minister, «we need to make the figure of the general practitioner more attractive, so that he becomes a specialist as happens in other branches of medicine; it must be clarified with general practitioners that their contribution in the Community Houses is essential – he added -. In the budget bill there is an important signal: 250 million are foreseen to hire staff for the Community Houses, in 2025 there will be 360 million” because, Schillaci underlined, “human “capital” is the most important”.
Mental health, another priority for the minister
And again, when asked about the mental health of young people who are increasingly at risk, the minister replied: «We are unlocking the “psychologist bonus” which, however, is not the only answer to give. We have set up a working group on mental health at the Ministry, we need to intervene above all in terms of prevention starting from primary schools and also combat stigma. Some regions have already expanded the range of services by establishing a basic psychologist.”
Waiting lists, lack of monitoring
Another topic addressed by the minister and also highlighted by the Corriere Salute survey is what Schillaci defined as the “age-old and painful problem of waiting lists, the worst perception that citizens have of the National Health Service”.
It was written in the 2019/2021 National Waiting List Government Plan: the regions should have transmitted the data to be published annually on the Ministry of Health portal. But this was not the case, as the Minister himself pointed out: «There is no effective system for monitoring the waiting lists. In reality we must have data because if we do not have precise data we cannot “cure the disease”. Our commitment, with the collaboration of Agenas, is to support the regions in the analytical collection of data, in order to be able to intervene”.
Another thing already foreseen by the National Waiting List Management Plan was the inclusion of the booking diaries of the accredited private individual in the Cup system – Single Booking Centre. The minister reiterated: «We must make sure to bring together the offer of the public and private sectors accredited in the regional Cups, and I know that Lombardy and Lazio are moving in this direction».
Telemedicine still at a standstill
The Corriere Salute survey also revealed that telemedicine is still poorly widespread. The minister commented: «The Health Service needs modernization. The other arm of the Pnrr, in addition to home care, is digitalisation and telemedicine, a starting point also for overcoming the many unacceptable differences, between North and South, but also between cities and small towns in the same region”.
The investigation
Over 8,500 people responded to the survey, with an average age of 61. Overall, 62% of respondents suffer from at least one pathology, the majority from hypertension (28%), heart disease (10%), followed by: tumors, diabetes, autoimmune diseases (for example: rheumatoid arthritis, lupus), obesity, asthma , chronic obstructive pulmonary disease, other pathologies such as thyroid disease, osteoporosis, glaucoma, BPH-benign prostatic hypertrophy, hypercholesterolemia, allergies. 38%, however, do not have any particular pathology.
As for lifestyle habits, 10% of the people who responded to the survey smoke habitually (mainly conventional cigarettes, about half a pack to a pack a day); 30% are ex-smokers and have quit more than a year ago; 54% have never smoked.
The majority (77%) regularly practice physical activity – especially walking – to keep fit, every day or several times a week.
Oncology screenings offered by the NHS, when the ASL does not send the invitation
As for oncological screening for the early diagnosis of certain tumors (colon rectum, breast, cervix) offered free of charge by the National Health Service (see Who) and aimed at certain segments of the population, survey participants were asked if they had received an invitation to do so from the local health authority. Well, for mammography (screening offered free of charge to women between 50 and 69 years old), 64% of the women who participated in the survey received the invitation from the local health authority and carried out the exam; 14% received it but did not carry out the service, while 22% did not receive an invitation to have breast screening. For the Pap/HPV test (free screening for women aged 25 to 64), however, as many as 60% of the respondents did not receive an invitation from the ASL; 31% received it and carried out the exam, 9% received it but did not carry out the pap test.
For fecal occult blood testing (colorectal cancer screening offered free of charge to men and women between the ages of 50 and 69), 52% received the invitation and took the exam, 27% did not. ‘received, 21% received the invitation but did not take the exam.
Family doctor, 1.7 percent do not have one
As many as 1.7% of the people who responded to the survey do not have a family doctor. The reasons? In many cases the family doctor has retired and has not been replaced.
Does the GP use communication tools to follow patients remotely? From the responses it emerged that 59% of doctors use the telephone, 62% email, 33% chat (for example, WhatsApp), 14% text messages, 10% none of these tools.
Overall, 74% of respondents have carried out visits to their GP’s office in the last year. Over 4 out of 10 patients say they have had some difficulty in carrying out visits to their doctor’s office, in particular due to limited times or days for visits (23%) or because the visits, upon reservation, were set very far in the future over time (15%), or due to long waits in the clinic and difficulty contacting the doctor to book (10%).
Overall, 3.2% of those who responded to the survey asked the doctor for a home visit but as many as 18% of doctors do not make home visits.
Specialist visits, 1 out of 2 paid due to long waits in the public
Overall, 84% of respondents underwent specialist visits. On average, one in two people had them done only for a fee, and not with the National Health Service. The reasons? As many as 87% made this choice due to long waiting times in the public.
Even among those who do not have health insurance that covers expenses, 44% have paid specialist visits only.
Integrated home care, difficult access for 1 in 4 patients
Survey participants were asked whether they have used the integrated home care (ADI) service for free in recent years (guaranteed by the National Health Service within the Lea-Essential levels of care ed.). Overall, 5% of respondents used the ADI. Among these, 79% used it for a family member, 16% for themselves. As for the type of assistance used, in 68% of cases the nursing service was used.
The survey shows that 77% of respondents had no difficulty in obtaining ADI, therefore almost one in four clients had problems accessing the service. Overall, 63% consider it an adequate service, 37% do not.
Among ADI users, 71% used it following hospitalization. Among these, only 53% received support for their activation after discharge from hospital.
Emergency room, 4 out of 10 people dissatisfied with the service
Overall, 34% of respondents have used the emergency room in the last 2 years. Over 4 out of 10 people (43%) are not satisfied with the service they have used. Most of the hospitalizations (88%) were carried out in the public, with the National Health Service; 66% had been planned: of these, 39% waited less than a month to be hospitalized, 43% for one to six months. However, the opinion on hospitalizations was good, satisfying 64% of respondents.
November 10, 2023 (modified November 10, 2023 | 8:08 pm)
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