What the parties want to do with health care after the pandemic

What the parties want to do with health care after the pandemic

Money, a lot. Health is not only the set of health policies: it is also the most important item of expenditure for the Regions, capable of moving at least 70% of the resources in the budget. The issue is hot, and not just because the world has just emerged from a pandemic. Demographics are unforgiving: the population is aging, chronic diseases are increasing and a reflection on the welfare state is underway throughout the West: can we still afford it?

Policies for the next few years depend on the answer. If positive, it will be necessary to find money to maintain a public health system capable of justifying itself with a decent level of quality and efficiency. If negative, it will be necessary to prepare the transition to private, usually based on insurance coverage. In this case, an increase in inequalities must be taken into account: those who have more will be able to take care of themselves better. Someone may not care at all.

Whose is the competence of health care? The National Health Service (NHS) was founded in 1978, based on the principles of universality, uniformity, solidarity. Before there were public mutuals - such as the National Institute for Health Insurance (Inam) - and private (corporate or professional). "The levels of assistance ensured by the various mutual societies were however uneven - writes Giuseppe Remuzzi, director of the Mario Negri Institute of Pharmacological Research, in his Health (non) is for sale - and thus the constitutional wording was certainly not complied with (article 32, ed) of equality in access to care ".

After the hangover of the Eighties (which led to scandals and well-known investigations which also involved a minister, Francesco De Lorenzo), all governments have tried to contain expenses. Linear cuts, Remuzzi argues, cannot be the solution: it is not simply a question of spending less, but of spending better. A first reform dates back to 1992-93. A second in 1999 (Bindi reform, from the name of the minister in office). Corporateization begins, which had, in the intentions, the purpose of reviving the system, also through the appointment of a general manager with managerial skills. The choice of the name, however, is up to politics.

The scheme above undergoes a shakeup after the constitutional reform of 2001, which divided the matters of exclusive competence of the State from those of "concurrent" competence. The former are expressly indicated, and for them it is legislated in Rome: the list includes foreign policy, immigration, currency, defense. For all the others, legislative power belongs to the Regions, in a sort of de facto federalism. It also means health.

Open questions "The right to health provided for by the Constitution has been guaranteed by the National Health Service - Filippo Anelli, president of Fnomceo (Federation of orders of doctors and dentists) tells sportsgaming.win - that it had the advantage of looking at people not in terms of their ability to pay but in and of themselves. He looked good during the pandemic. But over the years we have also seen how this system has been neglected and conditioned by choices that must make us reflect ".

“The first choice on which to open a debate is that there are twenty-one regional subsystems, which have not been able to fill inequalities: a person born in Caserta enjoys a life expectancy of 78 years, in Bolzano 85. No solidarity mechanism has been set up to allow Regions in difficulty to be helped ”, comments Anelli. And he adds: "The issue of recruitment is not irrelevant. Here the problem is structural: it is necessary to decide whether the NHS is made up of walls and machinery or by personnel. The recruitments are subject to the limitations imposed by the Staff Fund, still parameterized on expenditure historical 2004. Eighteen years later. "And the National Recovery and Resilience Plan (Pnrr)?" It allocates fifteen billion, but it does not solve the problem - says Anelli -. The plan allows you to change old machinery but does not allocate one euro for professionals. I believe that the theme is known to the parties, bearing in mind that the governors of the Regions themselves have produced a program that has led to a shortage of specialist doctors ".

Another major issue is the maintenance of limited number to the Faculty of Medicine, the object of the desire of many young people. The career as a doctor appears attractive, also because of the well-known television series. The parties are divided: the center-right is in favor of abolition, the center left to keep it. For Rings it is not necessary to change. “The problem is not the graduates, but the specialists - he says -. Ministers Grillo and Speranza have already intervened and the training funnel is starting to empty with twelve thousand scholarships a year. We do not need to liberalize the limited number, but to define in an optimal way and by law that every doctor with a degree is entitled to a scholarship. Nobody should be denied the opportunity to complete the training ”. However, there is no planning: "It has been established that one general practitioner is needed for every thousand patients, but there is no guiding criterion for hospital doctors", concludes Anelli.

Let's see the positions of the main parties. It is necessarily a synthesis, given the mass of proposals dedicated to the topic by the political forces:

+ Europe Center-right Forza Italia Lega Fratelli d'Italia Green Europe-Italian Left Italexit Terzo Polo (Italia viva-Action) Democratic Party Possible Popular Union 5 Star Movement The analysis of the programs of the parties running for the elections on 25 September sportsgaming.win passes the coalition and alignment proposals under the microscope, as the programs are published, to understand what recipe they propose for the future of Italy + Europe The basic philosophy of Emma Bonino's party is that of an enlargement of the competences of the European Union on health. Not only that: the emphasis is on the individual responsibility of the citizen with prevention and promotion programs for the health responsibility of the individual.

There is talk of "increasing the use of new digital tools, for example applications that measure parameters of personal well-being, within the prevention and health promotion programs", but it is not clear what it means and how you want to use them. Considering the privacy aspect, this is no small matter. Interesting point: rethinking the industrial policies related to the pharmaceutical sector, together with "precise rules on the possible suspension of patents as well as decisive support for the research and development of promising therapies, guaranteeing fair access".

Center-right Emphasis on local healthcare and local medicine in the common program of the center-right, with the strengthening of predictive medicine and an increase in the workforce of doctors and health professionals. But, as will be seen, the differences between the individual parties are substantial. There is also talk of the extension of ticket-free medical health services (without however indicating the coverage), reorganization of specialization schools in the medical area, revision of the national cancer plan.

Forza Italia An interesting point is the reform of the Gelli-Bianco law on the responsibility of healthcare workers. We quote verbatim: it would be necessary "so that the person who respects guidelines or good scientific practices in the context of behavioral and management models, must answer only for gross negligence, without prejudice to civil liability for an unlawful act, also to avoid the so-called" medicine defensive". Which, incidentally, costs a lot at the public purse. The idea seems sensible.

The Azzurri continue to fight against passive medical mobility, which forces them to travel in case of emergency and urgency and in the case of pathologies of low complexity; policies to standardize the essential levels of services in all Regions and for the development of centers of national excellence in the event of serious pathologies that require highly complex services. Finally, a proposal for abroad: extension to the entire period of stay in Italy of health care, including the family doctor, to citizens registered in the register of residents abroad (Aire).

Lega The League focuses on prevention and winks at the private sector, the flag of Lombardy administered by Attilio Fontana (although he specifies: “countering the push towards a health system that can introduce a predominantly insurance private model”). Openings also to the no-vax front: the party claims freedom of choice on vaccines, even in the presence of adequate public information campaigns to refer to. Compensation proposed for those who have suffered damage from the serums.

The Northern League program is characterized by the strong role recognized by the Regions (for example on recruitment), in contrast with most of the other parties, which after the pandemic prefer an increase in central coordination. Salvini is for the abolition of the limited number in Medicine: free registrations, first semester in common, then national test, the Milanese leader proposes. Whoever does not pass is out.

Among other points: the creation of a permanent training school for the NHS executive class (interesting idea); a national register of "heavy" equipment to help replace obsolete equipment; strengthening of the “service pharmacy” model; a plan for the RSA; more funds for mental health on the public front, considered to be deficient; a plan for cancer prevention, management and research, with contributions for low-income groups.

Fratelli d’Italia Public health at the center of attention for Giorgia Meloni. Among the proposals that characterize the party, unique in the panorama of programs, the increase in housing, medical facilities and essential health services for out-of-office students. A concise proposal that could open up many ethical and political debates is the one that provides for "screening procedures and strengthening of predictive medicine with a reward mechanism in accessing the health system for those who follow a regular and agreed path of health status monitoring" . Put like that, it looks like a kind of health points license.

Meloni then proposes the creation of a Health Authority, independent at the administrative level, with inspection and reporting powers to the competent authorities. Extension of the essential levels of assistance to basic dental care (therefore not aesthetic), which must therefore be guaranteed. Fdi also takes sides to abolish the programmed and closed number in Medicine. But, unlike the League, the selection would take place after the first year. Finally, on vaccines, the Roman leader also winks at no-vax: no obligation but institutional information campaigns.

Green Europe-Italian Left A program entirely geared to the public that of Green Europe-Italian Left. According to the Angelo Bonelli-Nicola Fratoianni tandem, the Draghi government, after the pandemic passed, did not follow up on the premises. “Today the weight of private healthcare accredited by the NHS is unfortunately enormous - writes the list -. Almost 50% of the hospitals included in the NHS are private, as are 60% of outpatient services and even 78% of rehabilitation services and 82% of residential structures. Obviously all this is not accidental: these are the most profitable areas. Certainly not territorial medicine where, in fact, the accredited private individual reaches only 13% ".

Among the proposals: contraception, abortion and free examinations and ultrasound scans during pregnancy; forty thousand hires in three years, promotion of the use of equivalent drugs, provision of an "adequate" public company for the production and marketing of drugs and vaccines; abolition of the tax advantages associated with the underwriting of health insurance policies and participation in supplementary health funds; overcoming the national conventions of family doctors, free choice pediatricians, outpatient specialists, service medicine with the inclusion of these professional figures in the single contract of dependence on the National Health Service, updating of the tariff nomenclator (today the one of the 1999) for prosthetic and non-prosthetic aids.

In addition, a plan for people with disabilities that includes the accessibility of public transport for the disabled and sexual assistance for the disabled (love givers). For families, the possibility of having “gods and” babysitters paid by the state for a few hours a week; public or affiliated psychologists at a controlled cost; 24-hour psychiatric guard; an online and offline portal (?) open to all to prevent the incitement to suicide and self-harm. The problem, however, is where to find the funds. Figures are missing, and with such proposals it is necessary to clearly explain how they are planned to be implemented.

On civil rights, the programs of the parties are at opposite poles Egalitarian marriage and Zan ddl for the center-left parties. No from the center right. The interventions in favor of people with disabilities are instead more shared, even if in some cases not very specific Italexit "Italy outside the WHO". This opens the Italexit health program, which declares itself opposed to any form of green pass and vaccination obligation. Gianluigi Paragone's party asks for compensation for citizens "unjustly suspended from work" and "immediately a commission of inquiry into the management of Covid". The abolition of the criminal shield for vaccinating doctors is also proposed. Among the proposals, the "overcoming of the concept of hospital company (so-called Bindi reform)". On the relationship between health care and politics, it is worth reporting what Paragone's party writes, because it is among the few to touch the knot.

“It should be remembered that with the Bindi reform hospitals have become headquarters for the management of political power, with the figures of general and administrative directors of exclusive political appointment often preceded by actual merits. Ineffective managerial management has led, over the years, to a progressive economic deficit to the detriment of the final product, that is, clinical care and patient health ". Hospitals, therefore, “must be managed by managers (better if doctors with managerial training) selected exclusively for merit and not for political affiliation. Managers must be free from conflicts of interest, must be included in a national list and will be selected by an ad hoc commission chaired by a magistrate ". Paragone is also in favor of the abolition of the limited number in Medicine.

Terzo Polo (Italia viva-Action) For Matteo Renzi and Carlo Calenda, funding for the NHS must not fall below the European average, and a share of no less than 3% of the National Health Fund must be allocated to research. Italia Viva and Action propose to reform the division of jurisdiction between the State and the Regions which is inferred from Title V of the Constitution. A hybrid model that leaves coordination to Rome, and to the Regions the provision of services with the granting of accreditation on the basis of "objective criteria" and territorial needs. In the event that the Regions are unable to guarantee the provision of essential levels of assistance, "the possibility of intervening must be guaranteed to the State".

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