The joke is circulating among family doctors: «They have found the solution to reduce waiting lists: cut the requirements for visits and tests. They fail to increase the supply, so patient requests decrease.” This is a simplification and the plan on waiting lists, anticipated on several occasions by the Minister of Health, Orazio Schillaci, does not only aim at cutting inappropriate prescriptions by general practitioners, but also at increasing the services acquired by specialists of the public health service but as a freelancer. Furthermore, there is the objective of exceeding the personnel spending ceiling (to date hiring cannot exceed the cost of 2004 reduced by 1.4 percent), but it is still not clear whether this provision which must be approved by the Ministry of Economy will already be included in the next decree.
The announcement
What is certain is that finally, after many announcements, the decree is about to arrive, as Minister Schillaci explained on Saturday: «We will present it in the next 15 days. In Italy there are many, too many medical tests. We want to improve prescriptive appropriateness. We have the precious collaboration of the Higher Institute of Health to develop guidelines that are unique throughout the national territory, which give certainty to doctors who prescribe the tests without risking anything.” The percentage of useless prescriptions is 20 percent, so this is the goal of the cut. As? Tracking prescriptions by type; establishing criteria to evaluate, based on the number of patients, whether the total number of prescriptions from a single GP is anomalous (at which point the Region will intervene). In an interview given to Messaggero, Minister Schillaci explained: «Defensive medicine is bad. It leads doctors to prescribe too many tests, overwhelms facilities, increases waiting lists. And I tell you as a doctor: it also confuses the attending physician who has to draw conclusions from many, too many, tests. We must prescribe to each person only the tests that the patient really needs.”
Another important piece included in the decree will concern the transparency of information given that there is no centralized system on the basis of which the real trend of the waiting lists can be monitored. Schillaci: «Today we read in the newspaper that a lady needs a year and a half to have an MRI. But we must take into account that in Italy there is no system for monitoring waiting lists. When we read some headlines, we have no way to check. We want that finally in Italy, region by region, with a central management, we can control where and what performances are lacking”.
Reactions
Clinics open for longer, prescriptions purchased with the intramoenia formula, monitoring of the phenomenon, new hires: these are the contents of the decree, but what is most controversial is the action against GPs who prescribe too many services. Filippo Anelli, president of Fnomceo (National Federation of the Orders of Surgeons and Dentists): «This measure on appropriateness is inapplicable, it had already been canceled in the past by the Constitutional Court. General rules and numerical criteria cannot be introduced on the health of individual citizens. There are other paths to follow.” Alessio D’Amato, national Welfare manager of Action, is critical of the minority parties: «A doctor prescribes according to science and conscience and everything cannot be bureaucratized. Appropriateness commissions already exist today, they must be put in a position to work. The problem must be tackled at its root with more staff and more resources. Instead, shortcuts are attempted.” However, Schillaci has been pointing out for days: “For decades we have been talking about waiting lists, we are changing the system.”
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