2024-05-24 00:34:00
“Today’s paradigm must change: either the family doctor or the emergency room”
“Covid with its disruptive effects was a stress test that highlighted the shortcomings that already existed and which undermine the universality and beauty of Italian healthcare legislation.” Thus begins the ad analysis Affaritaliani.it Of Fabrizio Pregliasco, director of the School of Specialization in Hygiene and Preventive Medicine at the University of Milan and medical director of the IRCCS Galeazzi Sant’Ambrogio hospital in Milanon the crisis of the national health system between very long waiting lists, hospitals closing and the flight of doctors and nurses abroad. “Sustainability over time is at risk due to some aspects. A large amount of money is allocated to fragile subjects either because they are elderly or even young people with pathologies. A 30% of the population absorbs 70% of the resources, making the system less efficient and with damage to the quality of services, for example, a diabetic person who is not taken care of and does not receive treatment ends up in hospital, and is therefore a cost, then he goes home and clogs up the system and is also ill”.
According to Pregliasco “Today’s paradigm must change: either the family doctor or the emergency room, often targeted with a third of white codes especially in the most delicate hours such as at night. In addition to staff shortages, there is a stickiness in the system that is now accustomed to working like this. We need to fill the gap between doctors, hospitals and citizens with services that take care of the population and structures that provide adequate responses. RSAs, for example, can make an essential contribution to local assistance. Let’s say it’s easy to find the problem but difficult to find the solution.”
But is it true that the government has cut money for healthcare? “Over the years there has been gradually less availability of funds and compared to the percentage of GDP there has been a problem of reduction of funds, especially compared to other European countries. And the problem is that the system is supported by general taxation and therefore they always pay the same ones, i.e. employees, the government has acted as a stopgap, for example by dutifully increasing salaries but the funds are not necessary for an overall reorganization of the system. There are around 30 thousand doctors and 70 thousand nurses missing and they are poorly distributed across the national territory. A series of professionals would be needed, especially for emergency rooms such as surgeons, anesthetists, emergency doctors, who do not have a good career prospect compared to other specializations such as ophthalmologists and dermatologists and therefore have less incentive to pursue these specializations”. “Even for the health professions and in particular for nurses the salary is not proportionate to the role and responsibilities of the profession and therefore unattractive for young people”.
“Europe has no competence for the moment due to the choices that were made when the EU was founded and the competences and responsibilities belong to the member countries. International institutions can play the role of facilitators of some dynamics but only as a non-decisive support, for example, the European electronic health record would be useful and, unfortunately, for political reasons, Italy is against the WHO Green Pass, an important tool for exchanging information in times of possible new emergencies in the future.” .
And what effects can differentiated regional autonomy produce? “It can exacerbate the differences between regions especially if the lep (essential levels of performance) are not well defined and the so-called lea (essential levels of assistance) at a healthcare level. There is a lack of services in the social and healthcare sector, for example transport which are in hand to volunteering or paid for citizens. And the large hospitals, the hubs, are also good but if they are 50 km from home they become a problem for citizens, especially the elderly. There is a lack of organization and fortunately the third sector often intervenesin Italy there is a great tradition of volunteers carrying out social and health services which becomes a very decisive tool.”
Finally, Pregliasco is very keen to send a clear message: “The accredited private sector plays an important role as a supplier of the national health system to be considered an ally of public structures to provide the best possible service to citizens. There are two types of private sector: non-profit, voluntary organisations, foundations, cooperatives, which guarantee around 80% of the places in the RSA often at the head of Catholic foundationsand the accredited private for-profit sector which plays a complementary role in the provision of services of the national health system which is public. In my opinion, therefore, we need greater collaboration with private non-profit and private profit organizations to best guarantee services to citizens through the necessary coordination and planning carried out by public structures”, he concludes.
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