Italy’s access to the health helpdesk of the European Stability Mechanism (Mes) involves a saving of 5 billion over ten years (as estimated by the Observatory of Public Accounts of the Catholic University directed by Carlo Cottarelli) or, according to a slightly different procedure, of 600-700 million a year (as estimated by Carlo Stagnaro and Luca Fava of the Bruno Leoni Institute). If we had had recourse to the Mes sanitary last spring, we could have strengthened hospital healthcare and strengthened it with military healthcare already this summer; we would have been better prepared for the autumn wave of the pandemic, which is now decimating hundreds of Italians and throwing millions on the pavement. An ethical responsibility even more than a political one for those who have the task of governing the country.
It is to be hoped that after the “States General” of the 5 Star Movement – an event that no one understands because it blocks the hands of the clock to the Italy that works and produces and above all that is not interested in a quarrelsome, inexperienced and on the avenue of sunset – the government it is decided to ask the support of the sanitary Mes Especially since the Resilience and Recovery Fund (RRF) will take a long time since even if an agreement is reached in the Bermuda Triangle (European Commission, European Parliament, European Council), the ratification of 27 Parliaments will be necessary to give the Commission new taxing capacity.
The Mes sanitary has no other condition than the financing of healthcare expenses (including current payments such as the support of scholarships for students and postgraduates in medicine or for fixed-term contracts, waiting for the roles to be expanded, for doctors, nurses and personnel in general). Common sense would like the Ministry of Health to present a program agreed with the Regions and Autonomous Provinces. It is quite simple to elaborate the hospital part of this program: most of the Italian hospitals date back to about forty years ago (even the “historic” hospitals were modernized tens of years ago) and, therefore, only the compliance and equipment of the latest equipment will absorb an important part of the sanitary Mes.
It is more elaborate to use the Mes sanitary for medicine in the area, general practitioners or family doctors and their aggregations or associations such as the Usca (health care units of continuity of assistance) which have developed in some parts of Italy and not in others ( and which allow groups of doctors to have a secretary or nurse and to operate over a long period of hours). The pandemic has shown that this is the essential level for detecting disease, providing first aid, and not clogging emergency rooms and hospitals with patients who can be treated at home. My personal experience as an economist with the suitcase who traveled the world when he was younger is that these associations were very effective in the United Kingdom and especially in numerous Länder of the Federal Republic of Germany.
In Italy the situation is at least confused. Alongside “doctors” of great value, there are situations that remember The Healthcare Doctor, the 1968 film directed by Luigi Zampa with an exceptional Alberto Sordi, ten years before the creation of the National Health Service. The legislation prescribes that the general practitioner guarantees health care indiscriminately to all patients enrolled in him. He makes sure to promote and safeguard health in a relationship of mutual trust and respect. It chooses the most appropriate forms of assistance also through medical associations. On the one hand, it has the duty to protect the overall health of its clients by using resources with scientific rigor and without waste. Ambitious goals. Difficult to achieve with the current system in which doctors are “affiliated” freelancers.
In particular, currently the medicine in the area is mainly made up of general practitioners (also called general practitioners or family) “affiliated” with a professional relationship with the relevant branch of the NHS (usually an Ulss or an ASL). The report provides 18 hours of work per week. They can certainly do many more. They are paid with a “per capita” fee (the number of citizens / potential patients) registered – as in Zampa’s film – and with a payment that varies from the service (visit, vaccination, etc.) according to a tariff. Estimates by trade unions in the sector state that a general practitioner or family doctor who is entirely dedicated to his “contracted” activity can have monthly revenues (before taxes) of 10,000 euros. Membership forms make it possible to reduce the costs borne by each doctor and to expand the services. In short, to extend a network of clinics throughout the territory.
It would certainly be desirable to establish a different relationship with the NHS: that is, one of dependence with variable remuneration depending on the hours that one undertakes to work. This would facilitate the development, not on a purely voluntary basis, of “group” medicine or “network” medicine to guarantee citizens a better service and offer them the possibility of contacting one of the other associated doctors in case of urgency and in case of absence of your doctor. Especially for services that cannot be postponed to the next day (even if only a certificate or a prescription for a drug is urgently needed) and in compliance with the schedules and organizational methods of the individual studies.
The program could be implemented gradually in line with the duration of the implementation of the activities financed with the ESM health service, also implementing the necessary consultation with the category. The sanitary Mes it will not have a significant effect on the supply of personnel at all levels, but the program could, or rather, should engage with the reforms of the RRF by eliminating bottlenecks in accessing medical schools.
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