According to many observers, the level of civilization of a people is measured by visiting its prisons. For others, the health of a nation is understood by the degree of maintenance of the roads: if the potholes multiply, the asphalt is missing or even the bridges begin to collapse, something is wrong. Economically, they make a difference tax evasion, public debt and medium and long-term sustainability: the first factor assigns to Italy the black jersey in Europe; the second makes it the sixth worst country in the world in relation to GDP; the third just the day before yesterday was lowered by Moody’s, the most important international rating agency: from “stable” to “negative”. There is enough to look at the future with great concern, without forgetting the international war context and another disturbing fact that concerns us closely: according to the United Nations, Italy is in fourth last place in the world in the birth rate ( only 7 new births per thousand inhabitants, against 44 in Niger, 41 in Somalia and 40 in Chad; worse than us on the planet are only Greece, South Korea and Puerto Rico).
EFFICIENT HEALTH
To these disturbing indicators we can add an eighth thermometer: the efficiency of the health system. “Here we are in good shape!”, One would instinctively say (especially if the “here” refers to the North, from Rome downwards the situation worsens considerably). Effectively, in the health sector, the international rankings see us shine: net of the pandemic, which hit Italy first and – inevitably – caught it unprepared with respect to the rest of Europe and the West, the National Health System projects Italy into the world elite. Even if we are not the country that invests the most resources per capita in health, according to the OECD, the number of doctors per inhabitant in Italy is higher than the European average (4 doctors for every thousand residents against 3.6), but above all we have one of the lowest rates of preventable and treatable mortality. It means that every year in Italy “only” 110 patients die (per 100 thousand inhabitants) who could have been saved with more effective prevention (against a European average of 160) and we lose “only” 67 (against 93 in Europe) due to inadequate care. In short, our doctors are good at both diagnosis and treatment. Again according to the OECD, in Europe only Cyprus boasts better numbers in health care and Italy stands out in particular for two data: the low number of hospitalizations for chronic diseases (such as asthma and diabetes) and the high survival rate from cancer.
LIGHTS AND SHADOWS
All right, then? Not really. Because reality is constantly evolving and among many lights there are also many shadows. Compared to the rest of Europe, for example, in Italy the cost of services to be borne by the patient is increasing more and more (in media our tickets cost 8% per cent more than the EU average), the number of hospital beds available is progressively decreasing and “the obstacles to training and hiring new doctors cause concern”. “More than half of active Italian doctors are aged 55 or over, the highest percentage in the EU ”, underlined the OECD report on European health in 2019. And since nothing happens by chance, the alarm that that report raised and that no one has heard about the ability of the Italian health system to cope with possible “sudden crises” sounds tragically prophetic.
POST-PANDEMIC WORRIES
Everyone knows what happened with the pandemic. But the problem of the problems is that Italian healthcare is struggling to get up even now that Covid-19 is under control thanks to the knowledge of the disease developed by doctors and – even more so – thanks to mass vaccinations that have not eliminated the infections, but have drastically reduced the consequences. Emblematic, to demonstrate the post-pandemic worries of the national health system, is the case raised yesterday by our newspaper: today – announced Ats Valpadana – the “continuity of care” service will not be active throughout the provincial territory due to the absolute lack of available doctors. In practice, there will be no medical guard, the one that takes the place of family doctors on holidays, so much so that “in case of need” the same Ats has suggested turning to the emergency room of the hospitals. Too bad that the ERs are already overbooked. In all likelihood it will end up that a patient with a green code or a yellow code (therefore with an annoying disease, mild or not serious, but not life threatening) today more than ever he will have to spend six, eight or even ten hours in the waiting room before he can be visited. Not the fault of doctors, nurses or hospitals, of course, but of a blatantly inadequate system. And it happens here, in Italy that works, in Lombardy which has always made efficient healthcare its flagship.
ASST, EXPENDITURE TO THE STARS
All the fault of the continuous cuts in resources allocated to public healthof the wink too often squeezed at private healthcare (which guarantees excellent ordinary services, but does not deal with emergency medicine) but also the fault of a limited number university system which over the years has literally “rejected” hundreds of thousands of aspiring doctors and nurses. Too many super crowded competitions (thousands of candidates vying for a few dozen available places) have not only frustrated the dreams of entire generations, but have inevitably frozen the turnover in the ward and in the clinics. Result: more and more senior doctors are resigning because they can no longer cope with endless shifts and hellish work rates, but also – it should not be hidden – because compared to the fixed salary they earn much more if they are paid per day by the hospitals forced to plug the uncovered shifts with on-call services. Cardiologists, radiologists and anesthetists, in particular, are almost nowhere to be found. Result: hospital companies spend much more (even a thousand euros a night for a coin operator!) for a worse service and are always in a frantic chase.
VICIOUS CIRCLE
Something similar happens to general practitioners, who earn a little more than their hospital colleagues, but are forced to find each other and pay for a replacement if they want to go on vacation. But since there are no substitutes, the only alternative is to close the clinic and suggest their patients to go to the medical guard. Which in turn is closed due to lack of staff. And divert the sick to the hospital. In short, today (and next week, on the occasion of the August bank holiday it will hardly get better) it is forbidden to get sick. In case of sudden abscesses, renal colic or illnesses caused by the scorching heat we will all find ourselves in the emergency room hoping for Providence. How to get out of this impasse? First of all by involving those directly concerned, asking them – the doctors – how to find the right balance between rules, needs and financial availability, because no one knows better than them what the wards, the system and the patients need. On the politicians, on the other hand, it is better not to count: after having brought down the government, they are too busy dividing the polling stations. Healthcare forced to raise the white flag due to lack of funds and personnel will think after 25 September. Perhaps.