Every reform evokes cuts. But this time the funds are there, and many, and so there Italian health reform – expected for years – promises to be a real revolution. The minister Roberto Speranza has been working for months a a 65 billion organic plan, covering a period of ten years, which asks to be partially financed by the Recovery Fund (and, who knows, by the Mes). The attempt to transform the Covid emergency into an opportunity, to change the health organization in the name of local services. The document – that the Courier service was able to read a preview – it is called the Reform and Resilience Health Plan Proposal. Version 34, which contains 23 projects and slides, was sent yesterday to the Minister for European Affairs Enzo Amendola, to start a process of confrontation with the Regions and in the Council of Ministers, and in view of a final landing in Europe. For months the ministry has been working a a circular healthcare model, in which the citizen is taken over by the system, the hospitals will only be for serious patients and the data will be put online. An ambitious project that focuses on territorial medicine, worth 25-30 billion, while as many are destined for a ten-year hospital modernization plan. But on these funds they will play a delicate gameif true that just the other day the premier estimated the European funds earmarked for health in Recovery p at just 9 billionlan, to which the 4 of the ordinary budget are added.
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The crisis of the system
The first reason for the reform is the acknowledgment that Italy is the oldest country in Europe and that there are 24 million chronically ill. The inhomogeneities between North and South are enormous. The beds per thousand inhabitants for the over 65s in the RSA are 40 in Bolzano, 24 in Piedmont, 3 in the South. The decree 70 of 2015 led Italy to have the lowest number of beds in Europe, without to create structures on the territory. Only Veneto and Emilia-Romagna have developed their own models. Now we want a national model.
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The Community House
So far the territory has been manned by family doctors. Now it is expected the creation of 6,000 Community Houses (one for every 10,000 inhabitants on average). Facilities open 24 hours, where teams will be formed with family doctors who will work side by side with nurses and specialists, having at their disposal analysis tools, from ultrasound scanners to spirometers. Telemedicine will make it possible to consult patients’ health records and to treat remotely. The Casa delle Comunit will also become the place for social and health integration. Another piece is the extension of home care. So far it covers 4 per cent, we want to reach 10 per cent, as in Germany, which is considered optimal. Third point, the community hospitals. These are intermediate structures, much more agile than traditional hospitals: 1,200 are foreseen, modules of 25 places for short stays, lasting 8-10 days. They will be especially useful in the post-hospitalization phase. To these are added hospices, counseling centers and mental health centers. We also want to define a new national system of environmental, health and climate protection.
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Integration
How to network the system? With the Siot, Territorial Hospital Integration System. There will be about one for each ASL. Unlike 118, the Siot will be contacted above all by the operators, who will take care of the patients to ensure that people are accompanied, from prevention to treatment. For schools, the creation of the health assistant (every thousand students), halfway between a nurse and a prevention technician. Furthermore, service pharmacies are to be developed.
Staff
Spending on health personnel is around 35 billion. To implement the plan, it needs to be increased by at least 2 billion a year. 45,000 units have been lost in recent years, and 60,000 are expected to be recovered. Doctors are not so much the problem (we have about 10 thousand, the same number as in Germany). There is a lack of nurses. The Regions don’t hire them not so much because there is no money, but because there isn’t. By defining plans and standards, the training process will be accelerated.
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22 October 2020 (change October 22, 2020 | 23:20)
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