That ugly healthcare mess

by Claudio Maria Maffei

19 APR –

Dear director,
let’s start from the graph taken from Istat’s BES 2023 Report published in Qs last Wednesday which shows how in 2023 the share of people in Italy who had to do without care amounts to 7.6% of the entire population, in increase compared to 7.0% the previous year. In the Marche this percentage in 2023 was close to 10% (9.7%), while in 2022 and 2019 it was around 7%. The data places the Marche in the third worst place (the Marche until 2022 was in the middle of the table) and is one of the many consequences of the political government of the Marche health system, since October 2020 (almost four years ago now) in the hands of the center-right and especially to Fratelli d’Italia. A healthcare that Prime Minister Giorgia Meloni would like as a model and the people of the Marche are starting to see it as a disaster.

At the same time as the release of this data, merciless in documenting the impact of the new Council on the “quality of services” (it is no coincidence that the Figure cited is found in the section of the same name in the BES Report), the crisis found ample space in local newspapers at the top of the Territorial Health Authority of Pesaro and Urbino, with the request for early retirement of the expert and competent General Director and the subsequent resignation of the Health Director. The matter in question goes well beyond a purely local significance, a discussion which also applies to the Marche healthcare issue which provides many useful elements for reflection at a national level. Let’s start with the healthcare crisis in the Marche region.

The center-right won the 2020 regional elections in the Marche with a non-programme, at least as regards healthcare. In moments of crisis (and the entire national healthcare system in the autumn of 2020 was in crisis due to the pandemic emergency) the generic promise of change may be enough to win. And since something had to be written in the program beyond the feasibility and sense of what was written, the center-right focused everything on two messages: a return to widespread hospitalism and the fragmentation of the Single Regional Health Authority into five Territorial Health Authorities, one of which (precisely that of Pesaro and Urbino) incorporated the Marche Nord Hospital which was abolished. All in the name of the aspiring Council’s mantra of “a healthcare system closer to the citizen”. This double choice was honored by the center-right once the elections were over. Except that this double choice generated the ungovernability that led to the two events from which we started: the instability of company top management and the crisis in the quality of services.

In Italian healthcare with its constraints (both overall economic and staff spending ceilings) and with its now structural problems (such as the shortage of staff, the unattractiveness of healthcare professions and the flight of professionals from public structures) choosing to engaging the healthcare system in a more fragmented and expensive corporate reorganization and keeping the fragmentation and dispersion of the hospital network not only unchanged, but even accentuated, has led to those results that the Council tries to hide and minimize. The example of the Province of Pesaro and Urbino appears truly paradigmatic. Faced with a substantially unchanged budget, this Company is called upon to draw up a Corporate Act on the basis of a Social Health Plan which envisages for the Province a new hospital for Pesaro with more beds than the current ones, the maintenance of the one in Fano around ten of kilometers with a new building for the first level DEA, an expansion of the Pergola disadvantaged area hospital with an operating block for highly complex surgery with 4 post-operative intensive care beds (you read correctly if you got as far as to here), three almost emergency rooms in as many Community Hospitals with specialized personnel provided by the relevant DEA (also in this case you read correctly), Community Hospitals for which the Plan provides for all sorts of specialist skills. It is obvious that the operation of drawing up a Company Act capable of implementing these guidelines (which are contrary to regulations such as Ministerial Decree 70 and Ministerial Decree 77) is an impossible mission, given that even the “ordinary” management of the budget is impossible. In fact, in the face of protests from citizens who can no longer tolerate delays and inefficiencies, the Council responds that it has no additional resources and that it is up to the Directors to find them because they have the autonomy to do so. Adding insult to injury: the Region binds the companies’ programming with the Plan, foreseeing an impossible expansion of the offer and then asks the Management at the same time to recover resources for current management. And this applies to the entire Region.

How the health system of the Marche can escape from this double squeeze (Plan to be respected and services to be offered) remains difficult to even imagine, given that the Region’s Health Building Plan is tailor-made for this illegitimate programming, a Plan that once started it will make it very difficult and very expensive to go back. In all this the Ministry and the Minister are silent and indeed are considered “supply chain” partners by the center-right that governs the Marche. It seems to me that there is something for everyone to reflect on, not just for us in the Marche region.

Claudio Maria MaffeiCoordinator of the Pd Marche Health Table

April 19, 2024
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