by Claudio Maria Maffei
03 JUN –
Dear director,
Italy debates the language used by Prime Minister Meloni in his meeting with the President of the Campania Region De Luca, but when it comes to health, Italians must not worry about how the Prime Minister says things, but they must worry about things that says. On Saturday here on Qs we found some of his statements in quotes about the waiting lists which make us understand how little the President knows and how much he pretends to know about such a sensitive issue.
I report those statements and then comment on them. First quote: “this is the Government that has put the most money on healthcare in the history of the republic, they are numbers, they are not opinions and it has linked those resources to the solution of two problems that no one had faced, namely the elimination of waiting lists and the chronic shortage of doctors and healthcare personnel”. Second quote: “And in the proposal there will also be solutions for carrying out visits, health services, which will also be carried out on Saturdays and Sundays, abolishing the spending cap for the hiring of doctors, involving specialists more, sanctioning those managers health workers who do not respect the objectives of reducing waiting lists and rewarding them if they do so”. Third quote: “We want to help the Regions that have jurisdiction over healthcare on waiting lists, providing the most effective tools to reduce waiting times.”
Let’s isolate from these sentences three statements worthy of a particular comment: that Meloni would be the first Government to address waiting lists, in the Decree or what will be there will be new solutions (opening also on weekends, greater involvement of trainees, abolition of the cap of spending for doctors, greater involvement of specialists, a system of rewards and punishments) and greater support for the Regions is expected. We preface the comment on these statements by thinking of resolving today with a Legislative Decree or even a Law a system problem such as waiting lists and talking about the latter without mentioning those for surgical services and those for critical territorial services, such as those of the area of mental health and residential care of all types, are already signs of a lack of knowledge that would suggest a pause for study and reflection.
The Meloni Government is not first, but very last in the list of governments that have dealt with waiting lists. The first legislation dates back to Law 23 December 1994, n. 724, which was followed, among other things, by three three-year National Plans for the containment or management of waiting lists (2006-2008, 2010-2012 and 2019-2021).
The “new” solutions that President Meloni talks about are either old, or rather very old (like the one on opening on weekends), or they are old and questionable (like the greater use of specialists already strongly criticized by CIMO in August 2020) , or they are old and illogical in their formulation (such as the reduction of the spending ceiling only for doctors) or they are absurd, provocative and self-defeating (such as the introduction of a generic system of rewards and punishments).
As for the most effective tools for the Regions, the problem is not to give the Regions more tools, but more resources and above all more controls, the latter especially when the centre-right has recently governed them. I torment and will continue to torment the Director of Qs with reports from the Marche, a model of a virtuous Region for the Prime Minister, in which public funds including European ones finance a healthcare system governed almost exclusively according to electoral consensus. Which translates into a dispersion of the offer, which is an important cause of waiting lists, especially those in the surgical area, including oncology.
But alongside the statements to be avoided in President Meloni’s speech there are gaps that are equally, if not more, guilty and embarrassing: no reference to the need to have a general practice capable of managing the demand and carrying out a series of first level checks , no reference to the need to remove from the CUP all the control and monitoring services to be managed with management processes supported by telemedicine, no reference to the disastrous effect of freelance work and private growth on induced prescriptions and no reference to the possibility of obtain benefits from the application of Ministerial Decrees 70 and 77 which the Government and Minister have now forgotten about.
Waiting lists are a complex problem that cannot be compressed by force of extraordinary and improvised measures, they are a problem that a mature healthcare system must learn to live with by continuously adapting the measures necessary to govern it. But populist healthcare is not up to the complexity of the problem and loves slogans and effective measures, which as such are useless if not harmful.
Claudio Maria MaffeiCoordinator of the Pd Marche Health Table
03 June 2024
© All rights reserved
Other articles in Letters to the editor
