The family doctor multiplies and becomes an entire study. Open every day, 24 hours and fully staffed with nurses and specialists. This is the main novelty contained in the draft of the health decree (27 articles) that Minister Renato Balduzzi should bring to the Council of Ministers as early as August 31.
According to what Giacomo Milillo, national secretary of the Italian Federation of general practitioners, explains to Ansa, the primary objective of this reorganization is to "move healthcare closer to the patient", lightening the emergency rooms and reducing the use of larger structures only when necessary.
“The patient will continue to have his or her doctor of choice – continues Balduzzi -, but within a study. And in the hours when his doctor is not there, the assisted person will be able to turn to other doctors who are part of the study, know his medical history and are able to follow him thanks to the electronic medical record which is also part of the proposals in progress. In practice, it is thought to be possible to go towards aggregations of 15-20 doctors, of which 15 are of choice and 4-5 of continuity of care, for example of emergency doctor, to then allow everyone to be of choice. We hope that other professionals will join them, such as nurses and specialists. The studies should also be equipped with basic diagnostic equipment, to reduce the use of complex structures to the bare essentials”.
Now let's see what are the other main provisions contained in the draft.
RATES AND INTRAMOENIA
The objective is to regulate the intramural activity carried out by doctors in private structures due to the lack of public healthcare spaces. Goodbye to cash: all payments must be traceable (by credit cards, debit cards, wire transfers or checks). The services will also have minimum and maximum rates.
When there are no public health spaces available, the ASL will be able to rent other structures or make external clinics available. Private practices must be connected via network to the company system and doctors who have chosen to be employees on an exclusive basis with the health service will not be able to work where there are non-employee doctors.
NEW CRITERIA FOR APPOINTMENTS
The decree aims at greater transparency in the appointments of general managers of companies and bodies of the regional health service. The Regions themselves will make the nominations "guaranteeing adequate publicity measures for calls for tenders, nominations and curricula, transparency in the evaluation of applicants".
The candidates, who at the time of appointment cannot be more than 65 years of age, must have "a master's degree and adequate managerial experience, at least five years in the field of healthcare facilities and seven years in other sectors, with managerial autonomy and with direct responsibility for human, technical or financial resources”.
ELECTRONIC HEALTH FILE
The electronic health record will have to be introduced by the Regions and autonomous Provinces. "Within 90 days" from the conversion of the decree law, a decree of the Ministry of Health in agreement with the ministries of Economy and Public Administration will establish "the contents of the ESF, the guarantees and the security measures to be adopted in the processing of personal data respecting the rights of the patient".
PUBLICATION OF PRICES FOR THE PURCHASE OF GOODS AND SERVICES
The reform also introduces the obligation for local health authorities to "publish online the unit prices paid for the purchase of goods and services".
TAXES ON SUGAR DRINKS AND SPIRITS
There is an extraordinary three-year tax for producers of spirits and soft drinks with added sugars and sweeteners. The aim is to finance part of the essential levels of health care (Lea) and the non-self-sufficiency fund. The expected revenue is 250 million a year. The tax will be 7,16 euros for every 100 liters of drinks with added sugars or soft drinks with synthetic sweeteners placed on the market. On the other hand, the levy for those who produce spirits is heavier: 50 euros for every 100 liters placed on the market.
TOBACCO FOR MINORS
Administrative fines ranging from 250 to 500 euros for the sale of cigarettes to minors and from 2 to XNUMX euros for repeat offenders.
A NEW DISEASE: LUDOPATHY
With the new decree, gambling addiction is considered a real disease. It will be possible to declare the non-attachment of the assets of those who agree to be treated. On the other hand, the installation of devices dedicated to gambling is prohibited within a radius of 500 meters of schools, youth centres, residential or semi-residential structures operating in the health or social welfare sector, places of worship.
With a reasoned ordinance, the mayors will also be able to order, for a maximum duration of 30 days, the closure or limitation of the opening and closing hours of commercial establishments, premises or gaming offer points in the municipal areas affected by relevant phenomena of gambling addiction.
"Further limitations - reads the draft - can be established by decree of the Ministry of the Interior, in agreement with the Ministry of Economy and Finance and with the Ministry of Health".
REVISION OF THE NATIONAL PHARMACEUTICAL MANUAL
The purpose of the review is to exclude from reimbursement drugs that are no longer of interest to the National Health Service. The aim is thus to reduce the price of those analogous drugs with a much higher treatment cost than other equivalent and not covered by a patent.
EXPERIMENTATION: HANDOVER BETWEEN ISS AND AIFA
All competences on clinical trials of medicines will pass from the Higher Institute of Health to the Medicines Agency. The measure should limit the proliferation of ethics committees. Furthermore, the online publication of documentation on clinical studies is planned.
HOMEOPATHIC MEDICINAL PRODUCTS
The simplification of the registration procedures for homeopathic medicines is coming soon.
LEA UPDATE
The essential levels of assistance (Lea) will be updated with particular regard to "people suffering from chronic diseases, rare diseases, as well as addiction to pathological gambling" in order to ensure "equity in access to assistance, the quality of care and its appropriateness with regard to specific needs".
MEDICAL CERTIFICATE IN THE GYM
To enroll in the gym or swimming pool it will be necessary to show a more detailed certificate of sound and robust constitution than in the past. At the beginning it seemed that the decree also required aspiring athletes - without any wish to compete - to be examined by a specialist in sports medicine, no longer therefore by the family doctor. As far as we know, however, the measure will not appear in the final version of the provision: the checks will be strengthened, but will remain in the competence of general practitioners.
