According to what we read in the newspapers, hear on talk shows and comment on social media, the gradual transition of the healthcare sector from a predominantly public system to a predominantly private one it would seem the most sensible choice. Necessary to eliminate, or at least reduce to a minimum the long and unthinkable waiting lists, to be treated in the best and most advanced structures in the sector. And so on. There are no viable alternative options on the horizon. After all, politicians, in recent years, have put the heavy load on it with the continuous cuts to funds destined for public health and triggering, we don't know how consciously, a vicious circle whereby "services get worse, the conditions in which they operate sanitary fixtures are becoming more and more difficult and, inevitably, the risks of serious errors increase». Complaints and requests for compensation against, almost exclusively, hospital doctors in the public health sector are also on the rise.
Doctors, the Local Health Authorities they work for and the Regions can protect themselves by taking out insurance policies that cover the risks of errors, which unfortunately happen. However, the exponential increase in complaints and claims for compensation have made the sector very unattractive for insurance companies, many of which have found themselves, over time, also having to manage, or attempt to do so, huge losses linked precisely to civil liability medical.
"Three exemplary cases reported by ANIA (National Association of Insurance Companies, ed.) in its 2014 dossier are enough to prove it":
* Lloyd's of London which, in 2012, had to inject 10 million pounds - of the 30 required of all shareholders for the capital increase - into the coffers of Lloyd's Market-form, which was in a liquidity crisis due to losses on the Italian market for medical liability.
* Faro Assicurazioni, a small Genoese company to which many Regions and hospitals in Italy had resorted. "In a short time the company was overwhelmed by an unmanageable amount of requests for compensation".
* The Romanian company Societatea de Asigurare-Reasigurare City Insurance SA, managed almost entirely by Italians and which boasted 90 percent of the contracts in Italy. «A series of investigations led to ascertaining her incompetence and, on 2 July 2012, IVASS (Institute for Insurance Supervision, ed.) forbade her to take out new policies in our country».
This has favored the birth of a new phenomenon, "so-called self-insurance". The single hospital or the Region from which it depends takes charge of the payment of the compensations, "basically, a powder keg".
According to Ania, the main causes of the increase in the number of claims for malpractice and compensation would be three:
* Greater awareness and attention of patients to the care received, sometimes even favored, especially recently, by some providers of dispute management services.
* A sharp increase in the amounts of compensation recognized by the courts.
* The expansion of the rights and cases to be compensated by the jurisprudence.
To improve the situation, ANIA, in a hearing in the Chamber of Deputies in 2013, put forward three proposals:
* Switch to a system in which, for certain series of events, compensation is provided, or rather a standardized compensation, without the search and attribution of responsibility.
* The review of the concept of responsibility through the introduction of protocols that exempt operators from liability if they are able to demonstrate that they have correctly performed them, or through a more precise delimitation of the perimeter of responsibility.
* Containment of recourse to ordinary justice through alternative dispute resolution mechanisms and discouragement of unfounded requests.
For Carraro and Quezel the best method to reduce the risks associated with malpractice is to provide health care with more resources and improve "the working conditions of employees, providing them with adequate means and more frequent opportunities to update their scientific knowledge and their technical skills".
Moreover, if on the one hand Ania fears negative developments resulting from the self-insurance of Local Health Authorities and Regions, mainly due to their inexperience in the sector, compared to an insurance company, on the other hand Ania itself which proposes the introduction of rigid protocols demonstrates the same lack of knowledge, in the medical field. The case history that doctors, surgeons and health professionals encounter on a daily basis is such as to make such an option unfeasible. Rather, it requires greater dissemination and constant updating of scientific guidelines, already partially in use.
The choices of politics, "declined in a thousand different and perverse ways" (from the blocking of turnover to the reduction of beds, from the unification of hospitals to the increase in co-payments, from the adjustment of the Lea - essential levels of assistance - to the elimination of essential services), appear to be "scientifically conceived to facilitate the process of destructuring the Italian health system". Francesco Carraro and Massimo Quezel underline the two consequences of this situation:
* Italians give up treatment, not having sufficient savings to do so.
* As in many other sectors of daily life, even in the health sector the citizen is forced to take out a mortgage.
In 2017, specialized credit institutes disbursed 400 million euros to patients forced to go into debt to guarantee treatment.
There is therefore no doubt that this phenomenon has generated «a business with very attractive contours» for those same insurance companies that are fleeing the medical liability field. "They call it the white economy."
According to data provided by Ania, «between 2013 and 2014, Italians paid out 2 billion premiums for health policies». But there is a rather disturbing implication and it is an insurance broker who told the authors of Salute SpA: «The policies are designed to pay as little as possible».
Paraphrasing the motto very popular among the bankers of the city of London, as reported by the journalist of the «Guardian» Joris Luyendijk in the essay Swimming with sharks. My journey into the world of bankers: «It's only OPM (other people's money)», one could almost say that insurance brokers operate according to the mantra: It's only other people's lives.
Salute SpA, the investigative book by Francesco Carraro and Massimo Quezel, published in the first edition by Chiarelettere in September 2018, is a very articulated and analytical text, which addresses the problem of malpractice in public health but, above all, investigates its causes. The three interviews, placed at the end of the text, with an insurance broker, a liquidator and a coroner are very interesting, because they enter into the heart of the discussion. They concretely tell the crux of the matter. Of the right to health, if it really is still such and if it ever really was. Of the gaps in public health. Of the shortcomings of what would so much like to present itself as "the second pillar", i.e. the insurance sector but of how, in reality, this lacks precisely, even if not exclusively, in what is the cornerstone on which the public healthcare: the mutualistic principle. Deconstructing the public health sector in favor of the private one means, inexorably, abandoning this principle. If it is considered the best solution, it can also be undertaken definitively as long as it is done with full knowledge of the facts and, above all, correctly informing citizens about it.
Salute SpA undoubtedly turns out to be an interesting read, not least because it invites reflection on fundamental issues that are taken for granted too often and too lightly. A book to read.
Reference Bibliography
Salute SpA, Francesco Carraro, Massimo Quezel, Chiarelettere (first edition September 2018).
Biography of the authors
Francesco Carraro, lawyer and writer, has been dealing with civil liability, medical in particular, and claims for damages for years. He is the author of “KrisiKo. The way out of the great game of crisis” (with Vito Monaco) and “Post scriptum. The whole truth about the post-truth”, both published by the Paduan publishing house Il Torchio.
Massimo Quezel, out-of-court attorney, has dedicated years to studying and training in the field of accidents, compensation for damages and medical professional liability, with the aim of acting as a counterpoint to the overwhelming power of insurance. In 2001 he founded a national network of consultancy firms whose objective is to protect the rights of injured parties in order to guarantee them the possibility of obtaining the right compensation. He is the author of the book “Assicurazione a delinquere” (Chiarelettere 2016).
