Called to reflect on tomorrow's public health, citizens and experts arm themselves with realism and design scenarios that are more similar to each other than one might expect, judging by the results of the survey Vote for your scenario on the future of Italian healthcare, promoted by Cergas and SDA Bocconi, BAA Bocconi Alumni Association in collaboration with Bayer Italia, and to which almost 6.000 citizens and 1.600 health professionals have responded in recent weeks.
“The most amazing convergences,” they declared Elena Cantu e Francesco Longo, the editors of the Oasi report on the health of Italian healthcare, presented this morning at the same time as the survey, "concern the willingness of citizens to close or reconvert minor hospitals and the forecast of insiders on containing salaries for healthcare managers". Contrary to what is suggested by the chronicles of the protests that always occur when small local hospitals are closed, 52% of the public prefer a small number of large hospitals, where technologies and skills can be concentrated and only 27% support territorial decentralization . On the other hand, if the preference of citizens for containing the salaries of healthcare managers can be taken for granted, it is the insiders themselves who judge future increases rather improbable (they give this scenario an average probability of 3,5 on a scale of 1 to 7).
Even in terms of waiting lists, citizens and experts agree: in times of contraction of resources it is preferable to limit the perimeter of the services guaranteed by the National Health System, but really guaranteeing them - that is, eliminating the waiting lists that characterize too many services today (61 % of citizens) instead of maintaining the current situation (13%). Experts give this scenario a probability of 5,2/7.
There are, however, differences between the public and insiders. If forced to choose (but a large number of them - 34% - do not want to answer) citizens prefer that an increase in services be financed by an increase in fees (22%) rather than by greater recourse to forms of private financing (insurance or direct disbursements by households -15%). On the other hand, insiders consider an increasing use of private insurance to be more probable (4,4/7).
Finally, the question of the decentralization of the health system divides the citizens themselves. Faced with the financial deficits accumulated by too many regions, a very narrow majority (45% against 44%) would prefer greater centralization to greater decentralization. However, the majority of those who live in the North are in favor of decentralization and the majority of those who live in the South are in favor of centralisation. Experts foresee ever more incisive interventions (up to actually reducing autonomy) by the central state in the event of a regional deficit. They also believe that regional deficits will increasingly be resolved through regional taxation, without national solidarity contributions.
“The results of this Cergas Bocconi study allow us to take a look at the future scenarios of our healthcare system. They help us to interpret the change taking place also thanks to the investments in innovation that lead over time to the development of new therapies, to be used according to principles of appropriateness", declared John Fenu, head of the Bayer Italia Pharmaceutical Division. “In line with our mission, we want to contribute to the development of a health system that is sustainable and that allows access to increasingly better health care for citizens. The same should guarantee patients the possibility of using the new treatment possibilities regardless of the geographical-regional context. These objectives are closer today, also thanks to the indispensable growth of the dialogue between operators in the health sector and citizens. Both voices must always be interpreted as a fundamental opportunity for listening and reflection for those who are responsible for finding sustainable improvements and solutions".
