An increasingly patchy healthcare system. With the richest regions, those of the Nordauthorized to pay their doctors (much) better than the others. And the white coats which, consequently, would have every interest in moving towards the VenetoLombardy and Emilia Romagna, leaving hospitals in the South unguarded. This is the scenario that the draft reform on differentiated autonomy Robert Calderoli is likely to draw on the front of the Healthcare. Because the “protection of health“, the text of the provision in hand, is one of the 23 subjects on which the Regions will be able, subject to agreement with Roma, gain much more margins of independence from the central government than today. With the Ministry of Health which would end up being relegated to the role of coordinator of a plethora of regional health systems that are also very different from each other. Starting with the salaries of doctors.
Autonomy in transport: risk of more expensive tolls in the North. Ports, railways and airports are also included in the Calderoli draft
THE PAYROLLS
Yes, because according to critics one of the most shaky points of the entire castle developed by the Minister of Regional Affairs is precisely the payroll knot. Because although healthcare is an area in which the regions already take the lion’s share, especially as regards budgets, today the fees of individual specialists are established at a central level, by negotiation between the unions and the ministry. Only an ancillary part of their remuneration, the variable one, can be adjusted upwards by the individual healthcare companies, especially as regards managerial roles. However, if the reform goes through as outlined in the draft, the scenario would change drastically. With the individual regions already pressing – Lombardy and Veneto in primis – to have carte blanche on the fees to be paid to doctors. After all, the lack of white coats, especially in emergency rooms, is a problem that also afflicts the North. And the concrete risk, indicated in the columns of Messenger also by the constitutionalist Vincenzo Cerulli Irelli, is to being faced with a real “exodus” of young specialists from the South to the North, attracted by better earning prospects. «For the national health system it would be the definitive stew», observes Carlo Palermo, president of the Anaao-Assomed union of white coats: «With an even more regionalized health, we could say goodbye to the collective agreement of the category. The result? The best professionals, or at least the youngest, would go to the North. And the right to medical care – he adds – would no longer be the same for all citizens, as the Constitution provides, but increasingly differentiated according to the postal code ». It is no coincidence that two other trade unions (Cimo-Fesmed and Aaroi-Emac) have also announced a battle against the reform.
The question, moreover, does not only affect the salaries of professionals, but also the scholarships for doctors in training. Today, in fact, it is the Ministry of Health that plans the number of places available in specialization schools nationwide, and therefore decides how many specialists are needed in each sector. If the system became regional, everyone would do for themselves. With the result that, in addition to being able to increase the monthly allowance for scholarship holders, the Regions with the most resources would have an easy time making more places available than the others. And the gap between North and South, instead of shrinking, would increase.
UNFAIR COMPETITION
To the point that there are already those who foreshadow the specter of “unfair competition” between Regions: a sort of upward auction to guarantee the services of the most difficult to find doctors (such as those in emergency-urgency departments). A race that would end up also involving the regulation of freelance activity, which could become a further factor of attraction for the most sought-after health professionals. Finally, the cost chapter. To raise it is the president of the National Order of Doctors Filippo Rings. According to which the direction to take – and the experience of the pandemic confirms it – is precisely the one opposite to Calderoli’s plan, i.e. a re-centralization of health. Also in order to better spend the resources available: «In the last four years the national health fund has grown by 14 billion, without considering the resources allocated to deal with the Covid emergency. Not only has all this money not reduced the health gap between North and South, but – attacks Anelli – it has not even translated into more efficient services for citizens. And it is difficult to think that the solution, in the face of out-of-control costs, is to further increase the shopping centres, instead of reducing them».
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