2023-11-28 11:02:19
Compared to other European countries, Italy spends “less than it should”. But by “spending better”, with adequate organizational models, “exploiting the network of centers”, keeping in mind, “in each clinical case, the cost-benefit ratio, better results for the patient could be achieved at lower costs”. This is how Maurizio Brausi, president of the Italian College of Surgeons (Cic), summarizes the contents of the session dedicated to changes in surgery to time.news Salute which he moderated at the Healthcare Forum which has just ended in Arezzo.
“Health spending on surgery – he explains – with 2,609 euros per capita per year, is much lower than the 3,269 euros of the European average. The ratio to GDP is also 8.6% compared to 10.9% of the average EU”. With these values, “Italy is in 13th place in the ranking of EU countries in terms of spending per capita: below the Czech Republic and Malta, and very far from France which spends 3,807 euros, and Germany which spends 4,831 euros per capita per year. year. And the forecasts for 2024-26 are not very rosy. Gimbe studies show that there will be a defunding of -1.3% in 2024”. One of the most critical situations “is the number of doctors and nurses”. Not only is “the number of surgeons decreasing – observes Brausi – even the training of our surgeons is not adequate. It must be modernised. In this Forum, healthcare was asked to organize fellowships, after the specialty, that is, periods of specialization in 2 years after the specialty that every surgeon could do in the area of interest”. Another critical point concerns medico-legal disputes: “The complaints from patients who undergo surgery are the highest in Europe – underlines the president CIC – In 90% of cases they end in nothing, but have very important implications both from an economic and psychological point of view on the professional who finds himself involved in these situations”. They function as “a deterrent for those who want to undertake the surgical specialty”.
We also brought some proposals to the Minister of Health Orazio Schillaci, “whom we met”, continues Brausi. Given the limited funding, we propose to “use the available funds in a more appropriate way. The first thing to do – lists the number one of the CIC – is to work with the Regions and together. It is no longer possible for the institutes and managements decide and that surgeons execute slavishly. There must be a shared decision. There are things that legislators and Regions can do, such as providing for the merging of surgeries, where possible, to reduce the number of doctors and nurses required, and therefore costs. Then it is good to use the network. In the case of Modena, which I know directly, with 7 urologies (2 hubs and 5 spokes), considering the small centers that belong to the large ones, the need for personnel, costs has been reduced , but also surgical waiting lists, which is very important.”
Another point on which to act is the management of surgical cases in a multidisciplinary manner (Mdt, Multidisciplinary Team). “This is especially true for oncological cases – underlines Brausi – It is necessary for the surgeon to discuss the case with the oncologist, the radiotherapist, the radiologist and the pathologist because, as demonstrated, by acting in this way fewer tests are performed and , at lower costs, better results. It is therefore a question of acting on Pdta, the diagnostic therapeutic care pathways”.
The meeting also discussed the diffusion of technology. “New technologies reduce operating times and determine an advancement in our work, but they must be sustainable – reiterates the president CIC – The robot, for example, must perform at least 250-300 cases per year. It is therefore advisable that the Legislator requires, for robots that do not reach this number of performances, “that they work on a platform and are used on multiple specialties, instead of just one. Their purchase should also be made based on the number of inhabitants”. We must not forget that “with robotics the number of surgeons in the operating room can be no more than 2, as well as nurses”.
Finally, “to reduce the costs of the actual surgery – Brausi continues – operating room and hospitalization times must be optimised, with the patient entering the day before and leaving the day after the operation, thus affecting the costs of hospitalization which can be around a thousand euros per day. We also have other technologies, such as mechanical staplers, coagulation and dissection equipment, stents, orthopedic prostheses, heart valves. The suggestion is to have meetings between surgeons, at regional, so that the legislator decides one or two types of devices to be purchased with a large-area tender. This – he concludes – would lead to lower costs”.
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