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Community homes, autonomy, pharmacies… where is healthcare going?

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Community homes, autonomy, pharmacies… where is healthcare going?

by Massimo Misiti

30 NOV

Dear Director,
the performance of the undersecretary Hon. Dr. Gemmato, pharmacist, continues on the revolution he would like to see in the national health system (Quotidiano Sanità, 25 November) and this time also brings up the minister, Prof. Dr. Schillaci.

Ministerial Decree 77 on the reorganization of healthcare, the territorial one in particular, the result of a period of emergency, must be revised, and it would be right for this revision to be done with knowledge of the territorial data linked to the complexity of the entire health problem, the needs territorial epidemiological and not on the interest of a category, as it seems to be doing, or of a bell tower.

In reading the history of the national statistical yearbook it can be highlighted how more than 200 hospitals have been closed in the last 12 years and now they want to be recovered with other functions and/or by inserting them in community houses. That the 1,350 community houses, and the 605 TOTs, Territorial Operations Centers, as stated by the undersecretary, are empty boxes for which “corrections of distortions” must be envisaged, one could also theoretically agree, given the lack of doctors and funds; but what cannot be understood is why every time one wants to lend a hand to the shortcomings in the Italian health system, today, one has to focus on pharmacies and on private ones in particular and not on hospital ones.

Fortunately, the distribution of funds for the health system and the new proposal drawn up between the Health and Financial Affairs Commission of the Regions has not yet been approved (Quotidiano Sanità of 29 November) the health system must not be isolated and managed by islands of power, coordination and knowledge of all paths should be unified under one guide, but this is currently utopian.

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The comparison, as such, is certainly necessary and should have priorities that do not only affect certain paths and/or categories, it would be necessary to think about the governance of the healthcare planet, the emergency/urgency network, the updating of the DRGs, without prejudice to for 11 years, on the study and publication of the implementing decrees of the Gelli/Bianco Law of 2017, on the planning of oncological prevention and time/dependent diseases.

Healthcare, and doctors in particular, are not ATMs. Whenever savings need to be made, it is done by reducing the fund allocated to healthcare and decisions are often made by weighing on the shoulders of healthcare professionals.

It would be interesting to have a path burdened not by watertight compartments but integrated with the skills of those who then respond to the needs of patients, because this is the priority point of those involved in healthcare.

And in this programmatic path, it would be nice to know the position of the undersecretary and of the Ministry regarding the proposal on differentiated autonomy in healthcare (QS of 16 November).

Massimo Misiti

Secretariat of the Italian College of Surgeons

November 30, 2022
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