Home » Territorial health. Once the resources of the Pnrr have been exhausted, over 1.2 billion will be needed to make home care and community hospitals work. The role of family doctors needs to be clarified. The doubts of the Parliamentary Budget Office

Territorial health. Once the resources of the Pnrr have been exhausted, over 1.2 billion will be needed to make home care and community hospitals work. The role of family doctors needs to be clarified. The doubts of the Parliamentary Budget Office

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Territorial health.  Once the resources of the Pnrr have been exhausted, over 1.2 billion will be needed to make home care and community hospitals work.  The role of family doctors needs to be clarified.  The doubts of the Parliamentary Budget Office

by Giovanni Rodriguez

And all this in a context of decreasing funding to the NHS. It therefore explains how, once the over 7 billion planned investments have been exhausted, various doubts remain as to where to find the funds necessary to guarantee the continuity of these services: from home assistance to community hospitals, up to the strengthening of those human resources necessary to ensure the delivery of services. To put all these critical issues on paper is the Parliamentary Budget Office (UPB) in a focus dedicated to territorial health care. THE FOCUS

14 MAR

With the funds of the Pnrr, Italy will be able to count on 7.5 billion euros to reform assistance in the area. An intervention deemed necessary given that the downsizing of hospital capacity – which is already low compared to other countries (the number of beds per 1,000 inhabitants went from 4 in 2005 to 3.2 in 2019, while the European average fell from 6.1 to 5.3) – was not accompanied by an adequate strengthening of territorial healthcare, with more evident deficiencies in some Regions.

Once these investments have been exhausted, however, several doubts remain as to where to find the funds necessary to guarantee the continuity of these services: from home assistance to community hospitals, up to the strengthening of those human resources necessary to guarantee the provision of services. To put all these critical issues on paper is the Parliamentary Budget Office (UPB) in a focus dedicated to territorial health care.

More in detail, from the examination of the territorial health reform and the prevention system, contained in Ministerial Decree 77/2022, three main criticalities emerge.

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First of all, some doubts are raised on the assessment of the current resources necessary to make the new territorial health care structures operational. Furthermore, when the resources of the Pnrr are exhausted, “more than one billion will have to be found in the funding to the NHS to give continuity to home care services and when the community hospitals will be available, 239 million will have to be found for the related personnel. Moreover, the financial planning for the three-year period that began in 2023 implies a reduction in the share of the product allocated to public health, which would make it difficult to enhance its services, even in the presence of a reorganization of the same”, explains the Upb.

“The need to allocate further funding to local health care will plausibly emerge – the focus continues – among other things, the Government has undertaken with the Regions to find additional resources where necessary, compatibly with public finance constraints With regard to the necessary strengthening of human resources, the difficulty of finding personnel and the loss of attractiveness of the NHS are becoming an emergency, especially as regards nurses and some categories of doctors, to be addressed with adequate personnel planning, the increase in the training offer, the adoption of measures aimed at restoring the attractiveness of work in the NHS in terms of social and economic recognition”.

Another issue that will have to be addressed is that which concerns the involvement of general practitioners (MMGs) in the implementation of the reform. This would require a clear regulation of the forms and methods of participation in the various structures and a revision of the training courses to strengthen them and adapt them to the new setting of primary care in the area. “The hypothesis of transforming general practitioners from contracted freelancers into employees of the NHS at the moment seems to have been shelved. The Guidelines for the agreement with the Mmg 2019-21 emphasizes the role of general practitioners aggregations more than that of the community houses and limits itself to assuming that the reorganization that emerged from the previous agreements is already consistent with the provisions of the Pnrr and adaptable to the new Regulation containing the standards of territorial assistance (DM 77/2022).The delay in national bargaining – the agreement under discussion today refers to a period that has now expired – it ends up being the cause and effect of the difficulties in introducing, and financing, more relevant innovations, which are also necessary from the point of view of the reform”.

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And again, it is emphasized that the new Regulation of territorial healthcare represents the instrument for ensuring uniform standards throughout the national territory, but institutional innovations will have to be lowered into individual regional models. Ministerial Decree 77/2022, in the final version of which the prescriptive part has been better identified, but also delimited, “leaves many solutions open, also with regard to the role of the private market, which will be able to find rather large spaces for expansion depending on the implementation choices of the Regions All the more reason, in order to ensure priority to the planning function, maintaining on the one hand control over expenditure and on the other hand the commitment to appropriateness and fairness in the provision of services, the role it will assume appears to be relevant the District, emphasized in the descriptive part of the Regulation and strengthened by recent provisions”, explains the Upb.

Finally, it is noted that some important aspects of the reform, such as for example the mechanism of integration with the social services managed by the social territorial ambits (Ats), whose personnel must be present in the Community Houses, and between the National Health Risk Prevention System and climatic conditions, established with Legislative Decree 36/2022, and the environmental protection system are still being defined. “This last aspect is also relevant in consideration of the recent constitutional reform, which introduces environmental protection and provides for limits to private economic activity in relation to the same environment and health“, concludes the focus.

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Giovanni Rodriguez

March 14, 2023
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