Covid has brought to light all the flaws in the health system, and the greatest of all has been paid for by the citizens on their skin: medical assistance in the area. In the most difficult weeks of the fight against the virus, one in three infected, frightened and abandoned at home, went to clog the emergency rooms, where only patients requiring complex clinical evaluation should arrive, and to occupy beds even if it could have been treated at home. –
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Covid has brought to light all the flaws in the health system, and the biggest of all has been paid for by the citizens on their skin (…)
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The hospital as the only point of reference, in a year of collapse, then forced to postpone visits and diagnoses, with consequences that we will see over time. The dismantling of assistance in the area for years has forced to go to the emergency room for anything, it increases improper hospitalizations especially for diabetes, pulmonary diseases and hypertension, while those suffering from chronic diseases worsen. Out of 21 million emergency room accesses each year, 16 million are green and white codes, and 87% of these do not result in hospitalization. It means that family doctors and intermediate structures could avoid an annual expenditure of 700 million euros. On the other hand, the expense for the lack of assistance to 23 million people with chronic diseases cannot be calculated. In short, a strengthening of urgent territorial medicine, and stronger, the lower the total costs of the health system will be.
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The document
Let’s see a preview of the concrete declination of the plan sent to Brussels to spend the 7 billion euros made available by the Recovery Fund, and to be spent in 5 years to change the Sanit model. The final approval of the project by the EU will arrive by September, immediately after, the Minister of Health Roberto Speranza will have to start the reform. Its five pillars are contained in detail in a document just presented behind closed doors at the San Matteo Polyclinic in Pavia by Agenas, the National Agency for regional health services that reports to the Ministry of Health. What does it actually change?
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The Houses of the Community
Point one. A crucial role of the new structure are the Houses of the Community which will bring together family doctors, specialists, nurses and social workers in a single neighborhood structure. The structure, equipped with a sampling point, diagnostic machinery for the examinations and the necessary IT infrastructures, together with the multidisciplinary team, will have to offer assistance from 8 to 20. The night service will be guaranteed by the presence of the medical guard. For widespread assistance, it is ideal to have a house for every 20,000 inhabitants. With funds from the Recovery Fund, 1,288 will be opened by 2026. Today there are only 489: the Region that has the most is Emilia Romagna (124), then Veneto (77), Tuscany (76), Piedmont (71). None in Lombardy, where 216 will have to be made. The government will decide how many to do in each Region, while it will be up to the Regions to decide where to do them.
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Community hospitals
Point two. You only need to go to the hospital for a serious illness or surgery. For short hospitalizations, and for patients with low intensity of care, contact the Community Hospital: a structure mainly managed by nursing, from 20 beds up to a maximum of 40. There must be one for every 50,000 inhabitants. Again with European funds, 381 will be created for 7,620 beds which, added to the existing ones, will have to bring the number of active beds in community hospitals to 10,783. Today there are only 3,163 places concentrated in Veneto (1,426), then 616 in the Marche, 467 in Lombardy and 359 in Emilia Romagna. It is not a question of building all new structures, but also of adapting and reconverting those that already exist.
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Domicile and operations center
Point three: home care. The number of patients followed at home has to be increased from 701,844 today, to over 1.5 million, in order to guarantee assistance to at least 10% of the most needy over 65 population. 5.1% followed today. Point four: the territorial operational centers (Cot). Their function of coordination and connection of the various local health services, supporting the exchange of information between health professionals and acting as a reference point for family caregivers. One Cot is needed for every 100,000 inhabitants, corresponding to each geographical area into which the territory (districts) will be divided. In total there are 602, to be organized within 5 years, of which 101 in Lombardy, 59 in Lazio, 49 in Veneto, 45 in Emilia Romagna.
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Family doctors
Point five: family doctors. Today they are affiliated freelancers: it means that their work is governed by collective agreements signed by the trade union representatives and by the State-Regions Conference. The agreement in force provides that the study must be open five days a week and the number of hours depends on the number of patients: it ranges from 5 hours per week up to 500 patients, to 15 hours for 1,500 patients, the maximum number allowed. As a condition of giving us the money, Europe is now asking us to review their rules of engagement, because the whole project risks crashing without the strong involvement of the family doctor who brings his clinic inside the Community Houses. The thorniest issue that the Minister of Health Roberto Speranza will have to face will therefore be to decide whether to make them employees of the National Health Service or transform them into a hybrid (outsourcing the work, where the doctor remains a contracted freelancer, but is recruited by cooperatives intermediates that guarantee the coverage of assistance in the Community Houses). This means that the Minister will have to be able to resist the pressures of those family doctors who wish to go ahead as today with their clinic to be managed in total autonomy, or rather to hire young doctors more willing to cover the needs of the territories.
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The realization of the plan
useful to remember that Similar reforms have already been attempted in the past: in the Guidelines of the Government program for health promotion of June 2006, the then Minister of Health Livia Turco wanted to create a new local medicine project through the promotion of the Casa della Salute, a multipurpose and functional structure capable of materially providing the set of primary care and to ensure continuity of care with the hospital. But, as we have seen from the numbers on the Health Homes that exist today, with few exceptions, the project ran aground both due to the unavailability of family doctors and to the various regional policies. The difference with then is that this time it will be the government to impose on the Regions the roadmap, the objectives to be achieved and the control over the results, precisely because the money comes from the Recovery Plan.
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(…) each Region (…) will assume obligations and, in the event of non-compliance, the Ministry of Health will be able to appoint an ad acta commissioner.
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the reason why each Region will be called to sign an institutional development contract, which means that it will assume obligations and, in the event of non-compliance, the Ministry of Health will be able to appoint an ad acta commissioner. The time schedule: the reconnaissance of the places to build Community Homes and Hospitals scheduled for the autumn, the exact definition of the street by March 2022, to then proceed closely with the signing of contracts.
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May 23, 2021 | 19:36
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