Doctor Sergio Segato, Director of Gastroenterology of the Sette Laghi Asst and head of AIGO’s Quality Committee, comments on the decree on waiting lists launched by the Government. The specialist considers the growth of productivity of hospital facilities, through the use of extraordinary services that healthcare personnel should perform beyond working hours, financially supported by extra funds. An approach that believes “destined to fail due to the evident weakness of many aspects, on which numerous scientific societies, including AIGO, have also expressed their opinions in the past”.
IN LOMBARDY THE TRIAL DID NOT BRING IMPROVEMENTS TO THE WAITING LISTS
The weakness of the regulatory system rests on the increase in performance without considering that the times of any visit or examination cannot be compressed beyond a certain limit. The risk is an inadequacy of care for the patient and a high risk for the professional: « The ineffectiveness of this political approach to the problem of waiting lists it has already been demonstrated with a trial conducted in Lombardy in 2022 – he claims Sergio Segato – on that occasion, through a public health intervention, all hospitals were asked to produce 10% more than the previous year. Once the result was achieved, however, the impact on the waiting lists was non-existent”.
Another aspect to highlight is the policy’s declared objective of hiring new medical and nursing staff to cope with the desired increase in performance. The administrations say they are willing to invest resources in this sense, but Our country lacks some professional figures capable of bridging the current and future gap.
THE RISK OF MEDICAL PLETHORA AND LACK OF PROGRAMMING
«According to OECD data for 2023 in Italy today there are approximately 4 doctors per 1,000 inhabitants, a figure slightly lower than that of Germany which stands at 4.6 doctors per 1,000 inhabitants. In our country, 18,200 graduates graduated from universities in 2023, compared to 12,400 in Germany. Having overcome the wave of retirements that according to trade unions will hit the sector in the next decade, the risk of a medical plethora, and therefore of an excess of professionals, is more than concrete. Also in the face of programming without any criteria of positions for medicine and surgery courses in our universities. The problem is very serious due to the imbalance that will remain, due to the lack of specialists in some medical disciplines considered less attractive”.
LACK OF NURSES “COLOSSAL ISSUE”
«Another colossal issue to face in Italy is the lack of nurses. Again OECD 2023 data estimates in our country 6.3 nurses per 1,000 inhabitants; Germany, on the other hand, has 12 nurses for the same number of inhabitants, therefore double. Our universities trained just over 17,000 nurses in 2023 compared to 44,200 in Germany. In light of these numbers, the absence of figures in this category to be included in hospital facilities therefore makes the question of hiring secondary” underlines the specialist.
FOCUS ON PRESCRIPTIVE APPROPRIATENESS
So what path should we take to reduce waiting lists? Like other scientific societies, AIGO has long been committed to the appropriateness front, understood as the characteristic for which the most suitable test is prescribed at the appropriate times for the individual patient. A modus operandi which is also a definition of quality. The how is indicated to us by the guidelines taken from the scientific literature which establish access to tests based on the patient’s clinical condition. A system at the basis of RAOs (homogeneous waiting groups) where those who provide the services and those who prescribe them agree on what the patient’s real clinical conditions are, for which different priorities are established based on the severity of the case.
«In Italy the approach toappropriateness is not very popular, because it involves a selection of patients eligible for certain services, but it is the only chance we have for the system to hold up. This approach has already been implemented in Lombardy: on 18 December 2023, legislation was approved that takes into account appropriateness criteria for endoscopic and vascular surgery examinations. Without the adoption of these systems at a national level it will absolutely not be possible to meet the objective of giving the right exam at the right time to the right person” concludes the head doctor from Varese.
Tests only if and when necessary: gastroenterologists dictate the rules to contain waiting lists
