by Claudio Maria Maffei
21 JUN –
Dear director,
I will not go into the merits of the validity of homeopathy regarding which I do not have sufficient knowledge. I am instead interested in the philosophy that is said (among others by the Mario Negri Institute) to be the basis of homeopathy and that is the so-called law of similars, which refers to the ancient concept of Paracelsus according to which “similia similibus curantur” or “i likes treat likes with likes.” If you think about it, the same concept inspires the law on differentiated autonomy which would push the Southern Regions towards greater efficiency, allowing them to recover the gap in the quality levels of services that separates them from the Northern Regions by accentuating it.
In fact, we read on the Fratelli d’Italia website: “Now, with autonomy, the Regions will be allowed to have more efficient services: schools, hospitals, support for families and the elderly, and the essential levels of performance and services will be guaranteed in all Regions so that no one is left behind.” The logical step that should link the process of differentiated autonomy to this realignment between South and North consists of a series of steps impossible to achieve in a reasonable time which starts from the definition of the Essential Levels of Performance, from the quantification of the resources necessary to guarantee them and from a strong initial and preliminary investment in the South capable of creating at least the conditions to fill that gap, which is not only a gap in resources, but also a gap in skills, experience and organisation.
Since, as healthcare abundantly demonstrates, the resources for this initial investment are not there and the political pressure within the majority for differentiated autonomy to start “anyway”, the risk of a further accentuation of inequalities between the North and South is very strong. Moreover, it is no coincidence that the strongest and most aware protests come from the world of healthcare, as demonstrated by the immediate critical interventions published here on Qs by Anaao, GIMBE, Smi and Fnomceo. Only Minister Schillaci insists on the drive towards efficiency that would come from differentiated autonomy, as evidenced by his words quoted here on Qs: “Differentiated autonomy already exists in healthcare. The Regions have great autonomy, little will change in this sector. But it can be a stimulus to improve for those who, perhaps, have not performed particularly well in recent years.” This is what happens when you make a doctor and university professor the Minister of Health, I would like to comment.
If, as the Mario Negri Institute of Homeopathy says, you avoid differentiated autonomy if you know it, however, the problem remains of how to combat the strong inequalities that pre-exist the Bill that promotes it and that make its supporters say that both It can’t get any worse than this and therefore we might as well try to change something. What innovators these conservatives are.
In healthcare we know well that the inequalities between North and South are maintaining and strengthening as demonstrated by the ISTAT data and the Crea report which were presented yesterday on Qs.
For this reason, credible proposals should come from the world of healthcare on how to address inequalities with alternative proposals to differentiated autonomy, proposals which however are currently lacking. Even in the more structured documents on inequalities between regional healthcare systems, such as those of GIMBE’s Svimez, there are a lot of useful data and calculations that quantify their weight, but there is a lack of indications on how to reduce them. Certainly greater healthcare financing and fairer criteria for allocating the Health Fund can help, but it is clear that they are only a small part of the solution. Just think of the structural deficit in the hospital supply of the Southern Regions at the basis of the impressive flows of healthcare mobility towards the North. Getting involved means simultaneously reducing the hospital supply, especially private ones, in the Northern Regions and strengthening and qualifying that of the Southern Regions. A long-term project on which no one, it seems to me, is working.
Two messages to take home: the best way to fight and avoid differentiated autonomy is to demonstrate that it has credible alternatives and healthcare may be the most suitable field to work on this demonstration.
Claudio Maria Maffei
Coordinator of the Pd Marche Health Table
June 21, 2024
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