The current National Health Service is no longer sustainable from an economic point of view. President Monti did well to draw attention to an irrefutable situation based on qualified national and international economic analyses. We must appreciate the courage of those who make public opinion aware of uncomfortable and unpopular realities. It is certainly not far-sighted to hide problems which, if not addressed and resolved quickly, will put the entire stability of the Italian economy at risk.
The current NHS is the result of regulations stratified in the past decades, often mixed with ideology and generous doses of demagoguery. Just think, as one of the many possible examples, of the regulations concerning the intra-moenia activity of the NHS health workers, which have not brought about significant improvements in the quality of assistance to citizens and their guarantees, which do not reward merit and which moreover, they do not appear to be applicable in most of the Italian situations. This situation has forced successive governments to continuously renew ambiguous regulations such as the so-called "enlarged intra-moenia". All at an additional cost which would amount to several hundreds of thousands of euros a year for taxpayers.
Given the current economic situation, the question that must be asked is whether it is possible to maintain the current levels of assistance and, if so, how to obtain this result which must be considered a priority for our country.
There are two possibilities: reduce spending and/or find alternative or supplementary organizational models to the current ones. Is it possible to reduce spending without affecting the current levels of assistance and without proceeding with linear cuts, taking into account the tight deadlines dictated by economic emergencies? The answer would be affirmative if politics really intended to take a step back in healthcare.
We are all aware of the recent scandals involving politicians of different alignments in various Regions. The administration of healthcare by politics undoubtedly represents a potential system of illicit financing, facilitated by the application of a distorted federal system. The amount of healthcare expenses delegated to the Regions represents one of the largest items in the state budget.
Among the meshes of this system it is easy to create opaque areas in which patronage systems and even illegitimate relationships with underworld systems with electoral consensus are inserted. What should really interest an efficient and modern State is guaranteeing the levels of assistance regardless of the method by which the result is obtained. "Privatising" may not represent blasphemy as long as the State maintains the necessary and continuous control of the quality of the services provided, with certain and exemplary sanctions for those who transgress, whether public or private.
In support of this thesis I report only one example among the many that could be cited. There are some healthcare services whose tariffs, established by the NHS, which incidentally should be standardized throughout the country as well as the purchase prices, cannot be respected by many healthcare companies due to organizational difficulties. Not being included in these tariffs due to waste, organizational inefficiency, often unjustified interests, contributes to creating the deficit. We should continue to consider it criminal to outsource these services to third parties, maintaining close monitoring of the quality of the services, also involving citizens' associations, guaranteeing payment solo than expected without exception? In this way, cost certainty would be obtained while maintaining the quality of services.
I want to remind you of another paradoxical situation which cannot be ignored if you want to rationalize spending. There are category health insurances in Italy (Casagit, Fasi, Caspie, etc.) managed directly or on behalf of important national insurance companies. This private assistance would involve about eight million citizens (thirteen percent of the population).
These citizens thus find themselves paying twice (to the category fund and to the State) for most of the same services. It would be appropriate to reconsider this situation, evaluating different forms of integration between the State and category insurance, while maintaining the fundamental principle of solidarity which establishes that those who have the most must in any case contribute to guaranteeing health care for the weakest subjects.
Each aspect addressed, having been reported by way of example and in broad terms, requires adequate study. Obviously, the problem is complex, the solutions difficult, since Healthcare represents the crossroads of a primary interest such as Health, where it would be desirable that ideology and opaque interests finally give way to efficiency, merit, objective evaluation of results.
PS the Constitution establishes the right to health for all Italian citizens. It would be more correct to speak of the right to adequate medical care and prevention. These should take into account universally accepted guidelines and protocols which take into account an adequate cost/benefit ratio. This distinction is not, as it seems, only lexical but expresses profound differences that deserve further study.
