For every 10 euros spent on healthcare, two are wasted. Raising the alarm on the sustainability of health systems, including the Italian one, are The Lancet magazine, which yesterday inaugurated the series of articles “Right Care” in London, and the OECD, which today published a report.
“The over-use and under-use of health services and interventions have reached epidemic proportions – reads the Organization's research – not only jeopardizing the survival of health systems around the world, but also undermining the possibility of a equitable and sustainable health coverage and the universal right to health care”.
According to the authors of The Lancet series, the excessive and unjustified use of health interventions of unproven efficacy and the under-use of effective services “coexist in all health systems to varying degrees, worsening clinical, psychological and social outcomes; resulting in an improper allocation of resources and, therefore, avoidable waste".
There are many examples: CAT and MRI scans are improperly used for back pain and headache, antibiotics for viral infections of the respiratory tract; bone densitometry, pre-operative tests such as ECG, chest X-ray, stress ultrasound in low-risk patients, antipsychotics in the elderly; cardiac imaging in low-risk patients, cancer screening of unproven efficacy (Psa, Ca-125), cesarean sections without clinical indications.
«The Lancet series and the OECD report - says Nino Cartabellotta, President of the Gimbe Foundation - are perfectly in line with what is reported in the 2016-2025 NHS Sustainability Report, presented by the Gimbe Foundation on 7 June at the Senate of the Republic . According to our estimates, in fact, in Italy about 11 billion/year are eroded by over- and under-use of healthcare services and benefits, to which must be added over 13 billion relating to fraud and abuse, purchases at excessive costs, administrative complexities and inadequate coordination of care'.
«Considering that the majority of healthcare interventions are placed in a gray area, where the risk/benefit profile is not so clear-cut – continues Cartabellotta – it is essential to take into consideration the preferences of the patients. This is why it is impossible to improve the appropriateness of health interventions without the involvement of citizens and patients through shared decision-making, a documented efficacy strategy to reduce waste, unrealistic expectations of patients and family members and medico-legal litigation".
