The Recovery Plan reserves 8.3% of the funds for healthcare. A quota considered insufficient by scientific societies that are asking for a sort of ‘Marshall Plan’ to be able to recover the enormous delays in medical visits, screening and surgical interventions accumulated in 2020 due to the health emergency. To indicate the way forward and the concrete proposals to be implemented is the “Permanent Forum on the National Health System in post Covid” promoted by various scientific societies.
Accumulated delays
The numbers of non-performance due to the pandemic leave no doubt about the delay to be made up: “In 2020 – the scientific societies state in the document – there were over 1.3 million fewer hospitalizations than in 2019, even the urgent ones were skipped (- 554.123). Oncological surgery admissions have seen a marked contraction and a decrease of about 80% of elective activity. Hospitalization for radiotherapy reduced by 15% and those for chemotherapy by 10% ”. In the cardiovascular field, the decrease was about 20% (implants of defibrillators, pacemakers and major cardiac surgery). It is estimated that hospitalizations in the medical area (largely converted and dedicated to hospitalizations of Covid patients) for chronic complex and exacerbating patients, have decreased by about 600,000 compared to 2019 “.
Mortality
Experts are also very worried about the very high mortality from Covid recorded in our country, the second in Europe and in the very first positions worldwide. “Mortality from non-Covid diseases is also very high, already recorded for time-dependent cardiovascular diseases and destined to increase significantly in the coming months and years also for oncological diseases”, continue the scientific societies.
The proposals of the Forum
The Forum is made up of 14 specialists, members of scientific societies and university professors. The first meeting led to the drafting of a programmatic document with many proposals: redefinition of the national health system, modernization of hospitals, re-foundation of territorial medicine, clear separation between hospitals, areas of care and assistance for Covid and non-Covid patients, advanced programs and structured telemedicine and restart of anti-cancer screening throughout the territory. Not only. Also information campaigns to reassure citizens about the safety of hospitals for returning to treatment during and after the pandemic.
Starting again from the hospitals
According to the members of the Forum, the restructuring of the health system must start with the hospitals. In Italy, the total number of ordinary beds per 100 thousand inhabitants is much lower than the European average (314 compared to 500) and places us in 22nd place among all European countries. “Health workers are inadequate for the population of our country: hospital specialists are about 130 thousand, 60 thousand fewer than Germany and 43 thousand fewer than France,” the experts explain.
Last in Europe for health expenditure
Italy is also among the last places in Europe for current healthcare expenses. Our country spends only 8.8% of its GDP on healthcare, which also includes 1.5-2% contributions from private citizens, while countries such as France and Germany exceed 11%. There is also a real ‘Southern Question’: the hospitals in the South are the most run down and risk not being able to provide adequate services to patients. The Recovery Plan envisages reserving only 8.3% of the funds for healthcare (18.5 billion out of 222): 7 billion are for the enhancement of local health care, 8.6 billion (3.9%) for technological updating of hospitals and scientific research.
Redesign the national health system
According to the Forum, it is absolutely necessary to redesign the National Health System starting from the shortcomings that emerged during the pandemic and using the conspicuous, even if insufficient, funds that will come with the Recovery Fund. “A rule, Ministerial Decree 70 – explain the scientific societies in the document – provides for the confirmation of the Hub and Spoke logic for hospitals by closing small hospitals, replaced by new local structures, community hospitals, managed mainly by nurses and partially by doctors, to absorb small pathologies. But the medical-scientific community has already declared its opposition to this type of measures ”. Even in the Recovery Plan, hospitals are considered as completely ancillary to the territory. “We are facing a serious underestimation of hospital-related problems,” scientific societies continue.
No to the minimum ‘proximity’ hospital
Even the planned structural and technological investments do not take into account the complexity and importance of hospitals. “We ask the government to reconsider the hospital issue by evaluating its structural, organizational and functional problems. Basically, we are opposed to the concept of a minimum ‘proximity’ hospital and, even less, to its management delegated to nurses. The community hospital represents an obsolete concept, excessively simplifying but, above all, inadequate to cope with the many and different complexities posed by the health demands of modern medicine “. According to the members of the Forum, the modern hospital by definition is a highly complex reality, which is not governed in a monochromatic way but is participatory, widespread and decentralized. “It is necessary – they write in the document – a modernization of the Italian hospitals, whose average life in many cases has well exceeded all plausible limits, often making them inadequate even just to host new technologies. And it is necessary to start an extraordinary information and communication activity aimed at citizens, a real ‘Marshall Plan’ for the recovery of the delays accumulated in screening, scheduled visits, follow-up visits and surgical interventions “.
The ‘team’ of the Forum
The “Permanent Forum on the National Health System in post Covid” is made up of Giordano Beretta (President of the Italian Association of Medical Oncology, AIOM), Ivan Cavicchi (Professor of Sociology of the Health Organization and Philosophy of Medicine), Francesco Cognetti (Coordinator of the Forum and President of the Together Against Cancer Foundation), Paolo Corradini (President of the Italian Society of Hematology, SIE), Roberto Gerli (President of the Italian Society of Rheumatology, SIR), Ciro Indolfi (President of the Italian Society of Cardiology, SIC), Dario Manfellotto (President Federation of Associations of Internist Hospital Managers, FADOI), Pierluigi Marini (President of the Italian Hospital Surgeons Association, ACOI), Vincenzo Mirone (Past President of the Italian Society of Urology, SIU), Giovanni Muriana (President of the Italian Society of Thoracic Surgery, SICT), Fabrizio Pane (Full Professor of Hematology, Federico II University of Naples), Flavia Petrini (President So Italian society Anesthesia, Analgesia, Resuscitation and Intensive Care, SIAARTI), Francesco Romeo (President ‘The heart We are – Italian Heart and Circulation Foundation’), Gioacchino Tedeschi (President of the Italian Society of Neurology, SIN) and Alessandro Vergallo (President of the Anesthesiologists Association Italian Hospital Resuscitators Emergency Critical Area, AAROI – EMAC).