“The shortcomings of the health system that have manifested themselves in all their drama with the pandemic cannot be liquidated with the sole cause of the cuts, which among other things exists only in part since, in any case, health expenditure in the last decade has increased on average by 0.8 percent each year. Instead, there is a serious problem of organization: an increasingly corporate and hospital-centric healthcare has impoverished an essential sector such as that of territorial medicine ”.
This is what Dr. Massimo Persia says, well-known toxicologist of Molise maternal origins (Bagnoli del Trigno) with years of experience as director of Serd in Guidonia-Tivoli (Rome), author of a volume of health management for top-level medical managers just released by PM edizioni.
“The numerous health care reforms in our country, I am thinking of Mariotti, the establishment of the National Health Service, the transfer of hospitals to the Local Health Units created in 1978 up to the season of extraordinary commissioners after the merger and reduction of the Local Health Services, have determined an ever stronger corporatization of public health – continues the specialist. “So today any doctor is also required to have an in-depth knowledge of the functioning of a healthcare company with its administrative and health policy bodies, its complex organization chart, governance, strategies, technological innovation, budget , reporting, precisely so that the services are organized in the best possible way. Now that we are still immersed in the pandemic, little is said about this node: yet it was above all the flaws in the health service, which needs a reorganization starting from basic medicine and the territories, to accentuate the sudden pandemic emergency. The most serious aspect, in fact, was that of having left so many people without any medical assistance, let’s think of the phones that rang empty. The hospital-centered vision has penalized precisely that territorial medicine which in many cases has failed ”.
In the book “Pathological addictions”, Dr. Persia also identifies critical issues in the limitations on access to degree courses in medicine and surgery, in the numbers scheduled for specialization schools since the 1980s and in the increasingly conflicting relations between the State and the Regions.
“The consistent growth in health spending recorded between 2019 and 2020, mainly due to Covid, records a strong regional differentiation – continues the specialist. “For example, Valle d’Aosta, Emilia Romagna and Bolzano showed growth rates of over 9 percent, Friuli-Venezia Giulia and Calabria around 2 percent, Molise a decrease of 8.4 percent. The repayment plans, as known, have characterized the economic and financial situation of many regions, already in 2006 Liguria, Lazio, Abruzzo, Molise, Campania, Sicily and Sardinia prepared them, in 2009 Calabria, the the following year also Piedmont and Puglia. All of this has had and continues to have a significant impact on performance ”.
In short, according to the author of the volume, in which other healthcare professionals have collaborated (Pierpaolo Aragona, Carlo Castelfranchi, Massimo Mattioli, Tonino Valleriani), it is necessary to relaunch the territorial role of healthcare and the centrality of healthcare management because human resources constitute the backbone of the system: in addition to doctors, nurses, technicians, psychologists and other health professionals, there are the URP operators, who played an important role in the pandemic period, and there is the relationship with many cooperatives that take care of canteen, cleaning and security services.
“Now there is the question of the post-Covid therapeutic and therapeutic diagnostic paths, that is, the problems of frailty linked to a patient who comes out of a hospital or in any case from the disease: the psychological and social because he is often depressed or physically unable to go shopping or pay bills. Reorganizing well, also thanks to funds from the NRP, is an urgent need “.