Article 32 of the Constitution states: “The Republic protects health as a fundamental right of the individual and interest of the community and guarantees free treatment to the indigent”. Never was a statement more disregarded. More and more citizens are giving up treatment and those who can are forced to turn to the private sector to be able to carry out services which, in the public sector, are not easy to obtain: for a cardiological visit, in fact, the average estimated waiting time in the National Health Service is around 400 days, for an abdominal ultrasound 600 days, for a breast ultrasound almost 500 days and for a lung CT approximately 300 days.
And this despite doctors applying the provisions of the “National waiting list plan”, inserting a priority code on the requested service, based on the patient’s clinical picture, to indicate the execution times ranging from 72 hours to 120 days. In the medical field, this is called appropriateness: doing the right thing, at the right time, with the right timing.
Despite the priority codes, the waiting lists are getting longer and longer. The public health service is simply no longer able to respect them, not even for cancer patients. These days, the USB Healthcare of Cagliari reports that the wait for a radiology oncology visit is very long and 194 cancer patients are waiting for an MRI to then undergo the resulting medical and radiotherapy treatments. And so throughout Italy.
What is the solution put in place? An upcoming decree to force doctors to cut the request for diagnostic and instrumental tests by 20%. Practically a decree cuts benefits. Can’t I guarantee them? I’m deleting the question at the source. I explained earlier what is meant in the medical field by appropriateness. Instead, for the bureaucrats, who now administer medicine, being appropriate means spending little and staying below a mathematical average.
This is what has been happening for a decade now pharmaceutical: as soon as you find yourself above the spending averagethe ASL prescriptive appropriateness commissions ask you to account, labeling the doctor as overprescriber. AND It’s a shame that the algorithm that decides the average has no consideration for the patient’s clinical situation, his needs or even the disorientation of old people who lose prescriptions and medicines while you are guilty of having prescribed 13 cans of aspirin instead of 12 in a year .
This is what will soon happen for the diagnostics, laboratory tests and specialist visits with the incoming decree. To be able to sign a prescription, a doctor must have attended a 6-year basic degree course, at least 5 years of post-graduate training, various refresher courses and continuous training and is required to comply with regulatory standards and good practices. So I think it’s more than appropriate, indeed it is appropriate by definition. The evaluation of his work should be qualitative: how I treat that person and not how much I spend to treat them.
But then who judges whether a lawyer, for example, is appropriate rather than an engineer or a politician? This treatment is reserved for doctors only.
While the crackdown on doctors and consequently on patients is coming, pharmacies are being financed with public money, giving pharmacists the opportunity to evaluate who has the right to have an ECG done free of charge, paid for by the NHS, rather than a blood pressure holter or a holter. cardiac. It will be possible to carry out as many as 3 ECGs, 3 blood pressure holters and 3 cardiac holters per year per subject in the pharmacy. I don’t think I’ve ever prescribed to anyone my single patient all these tests.
We must ask ourselves what clinical skills pharmacists can bring into play, compared to doctors who are asked to be “appropriate”. It’s like saying let’s let lawyers build bridges or let engineers speak in courtrooms.
And, in any case, we know that improper performance generates other improper performance, which further burden the NHS, worsening the situation of waiting lists to the detriment of patients who need treatment and diagnosis and putting citizens’ health at risk. While we take away the possibility of prescribing tests from those who have the skills to do so, we give it to those who do not have these skills because they are not doctors. In what other country in the world this is possible? On the one hand there is a crackdown with cuts to benefits, on the other we are witnessing the I waste of public money.
We certainly do not dispute the choice of a citizen to have a diagnostic test wherever he wants: in the hospital, in an affiliated centre, in the pharmacy or even in the supermarket; but if that exam is really necessary and is charged to the SSN, and therefore to general taxation, it must be prescribed by those who have the skills to do so.
The truth is that after 10 years of cuts to healthcare, around 37 billion, which translated into 100 fewer hospitals, tens of thousands fewer doctors and nurses, with the lowest GDP/health expenditure ratio ever and with the number of hospital beds increasingly reduced compared to other countries of Europe, the public health service is no longer able to sustain itself. The answer is certainly not to give away money to pharmacies, nor to purchase services from private individuals with resources earmarked for the public service.
