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Healthcare system to be reformed: protect the right, not the profit

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We like to consider it “the most beautiful health service in the world“. But the 128,000 deaths of this pandemic are a heavy legacy. We asked Nerina Dirindin what went wrong, and what reforms are needed.

The case

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by Donatella Zorzetto


Has Covid brought the problems of Italian healthcare to a head?
“It is undeniable that some territories have discounted the mistakes made in recent decades. I am thinking, for example, of the importance of collective prevention, territorial assistance, social and health integration. Fundamental aspects for public health, which we have often forgotten about concentrate solely on hospitals and specialist medicine. I want, however, to be optimistic: something is changing. Before the pandemic, those who affirmed the need to bring healthcare back to its original purpose, that is the protection of health as a fundamental right of the individual and in the interest of community, was considered nostalgic and obsolete. Today this statement is back in the news, as well as the importance of public health and the need to ensure that private health does not profit from the disease. Concepts that we have heard repeated several times by Minister Speranza and also by Pope Francis, and which I hope we will not forget when the virus begins to do without us fear: we need a cultural leap, which once again puts people’s health and its social determinants at the center “.

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by Fiammetta Cupellaro


The pandemic has also shown us the absence of a true local medicine.
“That’s right, and concrete actions are needed to rapidly strengthen territorial assistance throughout the country. Rather than new reforms, however, we need to implement the many measures adopted in the past and remain on paper. Some regions are still too slow in organizing the processes of taking charge, and I hope that also with regard to the Pnrr they will not wait for further information and the arrival of funds, but begin to prepare immediately, so as not to waste time when the time comes to spend resources and reorganize services “.

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Speaking of half-implemented reforms, what do you think of the National Chronicity Plan?
“The fact that, at least before the pandemic, all the measures were adopted without changing resources did not help. Incentives are needed to change people’s behavior, and probably also a generational change. The staff are, today, mostly unmotivated beyond that insufficient with respect to the assistance needs of the population: ordinary funds and a relaxation of the constraints on permanent recruitment will be needed, to avoid that after 2026 everything will go back as before. Many regions have also shown that they are not able to actually take care of patients chronic and frail elderly. Taking charge that must necessarily pass through the integration of health care and social assistance: we must have a structured social service integrated with health care, which provides services instead of simply transferring money, an anomaly the latter all Italian “.

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Health regionalism has also shown all its limits. Is it time to get over it for good?
“The fifth Title has many critical issues, but I think there is room for doing better even with the Constitution unchanged; in any case, healthcare close to people needs strong decentralized bodies. The central level has changed too little since it lost part of its skills: today it must establish citizens’ rights (the so-called essential levels of assistance) and monitor that they are respected in all regions. On regional health deficits, for example, a good job has been done, but the same cannot be said for as regards the protection of citizens ‘health rights, sacrificed almost everywhere with return plans (and not only). The central government should learn to act with more authority, reminding regions that where citizens’ rights are not guaranteed he can intervene, reaching the commissioner. Above all, however, a loyal cooperation between the state and the regions is needed. ano to unload the failures on someone else it is inevitable a contrast to the detriment of the people who expect more qualified and accessible services; loyal cooperation is something different than what we have seen in recent months, even during the pandemic. ”

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