That health care is a flagship of Lombardy, especially when compared with many other Italian regions, is beyond dispute. The question is whether it will continue to be so and what measures could be taken in the short term to guarantee it. These days we can already see the signs of the traditional summer crisis, a consequence of the (legitimate) holidays of the employees, but this time the risk is that the difficulties will not be overcome with the end of the holidays.
The most complicated situation is that of the hospitals which constitute the "front line" in relations with citizens and which suffer from a now alarming shortage of personnel. Lombardy (the data refer to 2014 and have not been updated) has the lowest expenditure in Italy for employees of the National Health Service, equal to 27,9% compared to a national average of 32,2%.
If you make a comparison with the Regions with budgets in order, Veneto is at 30,3%, Emilia-Romagna at 34,9%, Liguria at 35%, Tuscany at 35,6%, Umbria to 37,2%. This "gap" also concerns contracted personnel such as general practitioners (or family doctors) who are limited in number considering that most are over 55 and the specialization courses prepare an absolutely insufficient number of them.
Even more worrying is that our universities train trained doctors who in large numbers only find work abroad, especially in European countries, at the expense of the Italian taxpayer. The fact is that the lack of staff puts the quality of the service at risk. On the other hand, an increase in personnel expenditure of 4-5 percentage points would require the Lombardy Region to make an unsustainable financial effort.
All the more so when the State Health Fund is not yet able to guarantee the increase in the costs of the new employment contract which has seen the light after nine years of blockage. If it is difficult (and unfair) to go down the road of pure and simple cuts, there is only one way to mitigate the staffing criticalities to guarantee continuity and quality of service, that of rationalizing the system.
This means, with all due respect to localisms, unmotivated but aggressive and often fomented by a political class incapable of building the future, preparing a plan for the conversion of small hospitals from acute care facilities to centers for chronic diseases, especially for the elderly, for emergency medical pathologies and to prevent citizens from clogging up the emergency rooms of hospitals that have to treat acute cases.
Without wanting to "import" models, it would be useful to reflect on the reality of the health service in Great Britain which, with 63 million inhabitants, has 387 hospitals, while Italy, with 60 million, has 1400.
On the other hand, modest-sized structures are not recommended for citizens for obvious reasons even if it can be reassuring, from a psychological point of view, to have a hospital close to home. At present there are about twenty structures in Lombardy that could be reconverted. From this point of view, Lombardy is lagging behind other neighboring regions which have already reorganized the hospital system.
Of course, a quality service must be provided in hospital centers capable of treating patients who show acute forms of illness, but this must be the result of a serious reorganization project that closes nothing, increases the offer of services for chronic pathologies and allows to the "real" hospital facilities levels of having adequate staff to ensure quality and efficiency of services.
Basically, it is not a matter of spending less, but of making the best use of resources. Of course, if one thinks that the negotiation with the Government on regional autonomy will bring a flood of money into the regional coffers, one could continue to postpone the necessary choices. But that will not be the case and the clouds that are gathering over future state budgets, even in the presence of a complex and painless negotiation at European level, would advise us to make timely and courageous decisions by involving all the political and social.
Improbable comparison for climate, transport, orography, demography. Certainly from us parochialism and grabbing prebends. Primary schools with 4 beds, as the recent case of Naples, closed for holidays primary schools, such as universities, also located in small towns rather than enhancing existing ones