For years, the Italian healthcare system has grappled with a fundamental imbalance: a heavy reliance on oversized hospitals and a fragile, fragmented network of local clinics. In the province of Cuneo, where the geography ranges from the urban center to isolated Alpine valleys, this gap is not just an administrative hurdle—it is a daily reality for patients and the physicians treating them.
The current push toward sanità territoriale (territorial health), fueled largely by the National Recovery and Resilience Plan (PNRR), aims to shift the center of gravity from the hospital ward back to the community. However, the Order of Physicians of Cuneo, led by President Luciano Bertolusso, is cautioning that building new facilities is not the same as improving care. The reform’s success, they argue, depends on whether the system can move beyond a “mechanical” reorganization and actually reduce the bureaucratic weight that currently stifles primary care.
As a physician, I have seen how administrative friction—the endless paperwork, the redundant reporting, and the fragmented communication between specialists and general practitioners—erodes the patient-doctor relationship. In Cuneo, the Order of Physicians is advocating for a model where “less bureaucracy” is not just a slogan, but a clinical necessity to prevent physician burnout and ensure that elderly and rural populations are not left behind.
Beyond the “Brick and Mortar” Logic
A central pillar of the PNRR is the creation of Case della Comunità (Community Houses)—integrated hubs designed to provide primary care, nursing, and social services under one roof. While the physical construction of these sites is progressing, President Luciano Bertolusso has emphasized that the reorganization must transcend the simple shifting of activities from one building to another.
The risk, according to the Order, is the creation of “empty shells”—modern buildings that house the same inefficient processes and bureaucratic bottlenecks that existed in the old clinics. For the reform to be effective, the transition must be qualitative. In other words redefining the roles of the General Practitioner (MMG) and integrating them into a multidisciplinary team where the focus is on the patient’s journey rather than the facility’s occupancy.
“The reorganization must overcome the logic of simple shifts in activity to implement a real change in the way care is delivered,” Bertolusso has noted, signaling that the goal is a systemic evolution, not a real estate project.
The Bureaucracy Barrier in Primary Care
The “less bureaucracy, more care” mandate is perhaps the most urgent demand from the medical community in Cuneo. Currently, primary care physicians spend a disproportionate amount of their workday on administrative tasks—managing prescriptions, certifying disability, and navigating cumbersome regional digital portals—which detracts from direct patient interaction.
The Order of Physicians argues that for sanità territoriale to work, the digital transition must actually simplify work, not add a new layer of digital bureaucracy. The vision is a streamlined system where the Centrale Operativa Territoriale (COT)—the operational hubs managing patient flows—effectively coordinates care, reducing the need for the GP to act as an unpaid administrative secretary for the regional health authority.
Stakeholders and the Impact of Change
- General Practitioners (MMGs): Seeking a reduction in administrative load and better integration with specialists to avoid “diagnostic wandering” for patients.
- Patients: Particularly those in the Cuneo highlands, who require proximity to care to avoid long trips to urban hospitals for routine management.
- Regional Health Authorities (ASL): Tasked with the logistical challenge of staffing these new hubs amidst a nationwide shortage of family doctors.
- The Order of Physicians: Acting as the critical mediator to ensure that professional autonomy is maintained while improving systemic efficiency.
Adapting National Models to Local Geography
Cuneo presents a unique challenge to the national health reform. A standardized model of “Community Houses” that works in a dense city like Milan or Turin may fail in the valleys of the Maritime or Cottian Alps. The Order of Physicians is pushing for a flexible application of the reform that recognizes the “mountain reality.”
In these areas, the “territorial” aspect of health must be even more aggressive, potentially utilizing mobile clinics or advanced telemedicine to bridge the gap. The goal is to ensure that a patient in a remote village has the same quality of access to a multidisciplinary team as a resident of the city center, without the burden of excessive travel.
| Feature | Traditional Hospital-Centric Model | Proposed Territorial Model (PNRR) |
|---|---|---|
| Primary Focus | Acute care and emergency intervention | Prevention and chronic disease management |
| Patient Path | Patient seeks hospital for specialized care | Integrated care within the Community House |
| Admin Load | Fragmented; GP manages most referrals | Coordinated via COT (Operational Centers) |
| Access | Centralized in large urban hubs | Distributed across territorial hubs/valleys |
What Remains Uncertain
Despite the clear vision, several constraints remain. The most pressing is the human resource crisis. Italy is facing a systemic shortage of general practitioners, and building a “Community House” does not automatically provide the doctors to staff it. There is a lingering concern that without new incentives for young physicians to enter primary care and settle in rural areas, the new infrastructure will remain underutilized.
the exact integration between the private practitioners (who make up a large portion of the MMG workforce) and the public health system within these new hubs requires a delicate legal and contractual balance that is still being negotiated at the regional level.
Disclaimer: This article is provided for informational purposes only and does not constitute medical advice. For specific health concerns or policy inquiries, please consult a licensed healthcare provider or the official portals of the Ministero della Salute.
The next critical checkpoint for the Cuneo reform will be the upcoming regional reviews of the PNRR implementation milestones, where the Order of Physicians is expected to provide further feedback on the functional efficiency of the first operational hubs. These evaluations will determine if the transition is moving toward genuine clinical improvement or remaining a structural exercise.
Do you believe the shift toward community-based care will solve the access crisis in rural areas? Share your thoughts in the comments or share this story with your colleagues.
