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Let’s fight for public health

by admin
Let’s fight for public health

January 25th
Dear Director,
there are two aspects that, in the future, are bound to further weaken our public health. They are largely the same ones that have profoundly and negatively marked our recent past, with the addition that the season of reforms, which has just been undertaken in the absence of personnel, will aggravate their scope and weaken the public in favor of the private sector. One aspect is of an economic nature, the other more purely of a regulatory nature. Both in line with that ideological vision that the private sector has been feeding for years and which, thanks to the control of the media, first gave way to the denigration of workers and the public service, to then open increasingly large market shares to the private sector.

The economic element, which has been known for some time, has emerged very clearly from the recent Report of the Court of Auditors to Parliament which clearly highlights the attempt, made over the last 20 years, to weaken and crumble our public NHS. In fact, the report shows that, from 2008 to 2019, while the percentage of healthcare financing in Germany grew to 81.4, France to 34.5 and England to 40.1, Italy grew only by 15.4. Only Greece is worse. The effort made in the two-year period 20/21, due to Covid, was also lower in Italy: 15.5% compared to Germany 17.3% and the UK 27.2%. The French cumulative data is missing. In terms of absolute values, the gap between these countries is abysmal.

In 2008, an Italian citizen spent 2,279 euros on treatment, 500 euros (17%) less than a German, French and English citizen. In 2021, an Italian citizen spent 3,052 euros, i.e. 3,300 euros less – less than half, therefore – than a German citizen who spent 6,352 euros, and 1,500 euros, i.e. a third less, than a French or English citizen who spent around 4500 euros. Nor do we expect great recoveries unfortunately.

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In the multi-year DEF, the government even provides for a further definancing of public health to fall to 6.2% of GDP in 2025, which will position Italy 1 point below the OECD average (about 20 billion), 4 less than Germany and 3 less than France and the UK. Alongside the evident under-financing of the NHS, the share of resources invested by the public but ending up in private hands has grown in the same years. In fact, over the years, above all, expenditure on personnel has fallen, which is instead the key element of a public system!

In 2002, employee compensation expenditure in healthcare amounted to 35% of the total, in 2018 it was 30%, today it is 29%. For this same item, in nominal terms, compared to the total amount, there was a peak in 2010 with 36.7 billion, which fell in 2018 to 34.8 billion. Today we are at 38.1 billion due to the slight 20/21 Covid-related increases, which are also putting the budgets of the regions with the greatest public vocation into crisis due to the failure of the last 2 governments to offset the Covid 2021 expenses. The ten-year freeze on contracts, the containment of salaries and turnover are the basis of these data.

In the same period, on the other hand, intermediate consumption in health care grew from 20 to 30%, effectively configuring a transfer of public resources into private hands. In conclusion, the logic of underfunding and staff cuts in the decade 2009-2019 had brought the NHS to its knees, as the pandemic has mercilessly demonstrated. The loss of 40,000 beds and 37,000 civil servants in the national health system was the direct consequence of these cuts.

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The persistence of the freeze on hiring expenditure in 2004 minus 1.4%, decided by Minister Brunetta in 2009, always reiterated except for brief and insignificant parentheses, is at the basis of this dynamic which has weakened the public system. The health care investment policy for separate silos does not allow for transfers and, precisely because of the hiring freeze, prevents the increase in personnel expenditure.

Thus we are witnessing a double paradox: even if overall funding were to increase, the workforce would remain blocked; if a region wanted to increase personnel, even with unchanged expenditure, it could not do so because it would go beyond the personnel expenditure ceiling set over 15 years ago. So we are in a double straitjacket that weakens the public system: an overall spending limit and a hiring freeze. In practice, the private sector is safeguarded and the public is hit, who cannot hire them to respond to the new needs linked to the aging of the population, to the consequent growth of chronic conditions, to the appearance of new insidious pathologies. This encourages you to outsource.

Weakening the public in order to first discredit it and then replace it with the private sector is a well-known recipe that we have learned and tried on our skin. Even the theme of attacks on sanitary ware is often the poisoned fruit of this narrative.

With this perverse dynamic we are preparing for the reform of the territorial medicine of DM 77. A reform that sees large structural and technological public investments thanks to the PNRR. Community houses, community hospitals and territorial Operations Centers will not take long to physically take shape. But who is how will he bring it to life? Nothing or almost nothing is foreseen from the point of view of public recruitment. So who will populate those structures financed by public resources? If you don’t remove the spending block constraint for public recruitment, the answer is obvious! The private thank you for yet another gift!

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We have never been inclined to the rhetoric of heroes, we have done our duty, honored the social pact and the professional oath, but we do not deserve another betrayal. The already heavily impoverished citizens do not deserve it. If there is not an act of withdrawal from the government, all the trade union forces will have to bring together and forcefully the issue of protecting public health as a fundamental right of the individual and in the interest of the community…. as stated in article 32 of our republican constitution.

Pasquale D’Onofrio
Regional Secretary FP Cgil Doctors and Health Managers Tuscany

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