The “Boullette decree” approved yesterday also contains a substantial chapter dedicated to health care. The law will limit the use of paid doctors and will support pharmaceutical companies with a reduction in the amounts due for the so-called “payback”.
As far as outsourcing is concerned, the declared objective is to lower public health costs, raise quality standards and make the “token holder” career less attractive than the ordinary one, given that the increase in the workload due to pandemic is generating an escape from the permanent place in the hospital. Outsourcing must have a maximum duration of one year that cannot be extended and may only concern emergency and urgent services, i.e. first aid.
The ministry of health, with the help of the anti-corruption authority, undertakes to set maximum rates to remunerate the professionals hired for this purpose, who today earn 100-150 euros an hour. Contracted doctors will have to possess the same qualifications required of hired doctors, while today under an outsourcing regime it is possible to work in the ward without specialization. Post-graduate students will also be allowed to take on these tasks, up to a maximum of 8 hours per week for a fee of 40 euros per hour. Another novelty: professionals who have worked in any capacity for at least 6 months in hospitals will have an advantage in public competitions. Finally, doctors who leave the hospital to become token holders will not be able to return to public health.
The decree also provides incentives for emergency room doctors who work overtime, a provision anticipated by the allocation of 200 million euros in the latest budget. “The path is right, but it is not said that it is enough” is the comment of the president of the Medical Orders Filippo Anelli to the newspaper il Messaggero. “As well as on the economic level, action should be taken to improve working conditions”. The risk is that coin-operated doctors are not replaced by new hires, and that it is the user who pays the price.
The decree also aims to resolve the dispute between the Regions and pharmaceutical companies on the so-called payback: it is the rule that obliges companies to participate in the rebalancing of the accounts of the Regions that exceed the spending ceilings for drugs and medical devices, generating greater profits for companies. The mechanism has existed since 2007 and for 2022 it amounts to around 2.2 billion euros to be paid to the government. However, these payments are disputed by companies in a large number of administrative appeals that also concern past years, and so far they have largely remained on paper. With yesterday’s decree, the government has allocated 1.1 billion euros to cover part of the spending of the regions in 2023, meeting companies that opt out of litigation with a further discount based on the VAT deduction.
The exchange is judged “unacceptable” by the president of Confindustria Medical Devices Massimiliano Boggetti: “The payback must be canceled” he said even before the government meeting began. «This measure – concluded Boggetti – will decree the end of the National Health Service and the attractiveness of our country on the part of medical device companies. For this reason we intend to go ahead with the appeals to the Tar ». The prime minister’s party is with the entrepreneurs and intends to cancel the payback: “I undertake to try to carry out this operation”, said Francesco Zaffini (Fdi), senator and president of the Social Affairs Commission yesterday.