Ten “practical” proposals for a different public-private relationship in the acute hospital sector

We will now witness an election campaign in which everyone will emphasize the importance of the public health system and the centrality of the adequate treatment of the staff who work there. Unfortunately, if the political will does not translate into coherent action, the goodness of the principles (which will also be shared by all) will neither improve the assistance to the citizens nor the satisfaction of the operators.

27 CHRISTMAS

Anaao Assomed has the great merit of continuously reminding of the need to provide a different regulation to the public-private relationship in the hospital sector.
He did it very authoritatively also two days ago here at QS with an intervention from Florianello, Palermo and Di Silverio.

Based on this intervention, I propose ten points that I consider appropriate to develop during the revision of Decree 70, to which they refer, and/or with ad hoc measures:

  1. better analyze and monitor the data to highlight trends and criticalities: no official elaboration from the SDO report, the Statistical Yearbooks of the National Health Service and the National Outcomes Program provide information on private versus public hospitalization, and Agenas itself has provided little useful analysis in this connection;
  2. set thresholds for accreditation and notability for contractual agreements with private persons in terms of beds higher than the DM 70 currently in force (60 beds for acute patients): the AIOP proposals instead provide (and should not be accepted) a redefinition of the limitation of 60 beds with acute care beds with the inclusion in the 60 beds also of post-acute care beds related to acute care activities and the possibility of single specialist structures of an “extended” definition with a threshold increased to 30 beds;
  3. ensure a greater involvement of private structures in the emergency situation (including those of a pandemic nature) and in complexity: it is a point connected to the previous one, which plans to reach a smaller number of private structures with larger dimensions with an activity in urgent cases and to handle complex cases safely;
  4. to make the client more obliging in terms of both production orientation and control at the same time: today nursing homes often compete simply and simply “under the house” with public structures;
  5. impose a cap on the use of freelance specialist staff: for doctors (especially in the “senior” surgical field) there is a large market to be controlled;
  6. ensure that professionals who voluntarily leave the public system in the first three years cannot carry out activities “by agreement” in the private structures of the competence region: one cannot helplessly watch specialists flee from public structures;
  7. to exclude forms of remuneration that link it to a percentage of the value of production: it is not good that the more you produce, the more you earn;
  8. commit private structures to the traceable prescription of tests and medicines: it cannot be that this activity is downloaded to general medicine;
  9. make sense of regional health policy choices and corporate choices of hospital management: the irrationalities of public hospital networks (dispersion and unbalanced in emergency situations) and the organizational inefficiency of many public hospitals (think of the operating blocks) are a big push to escape these hospitals;
  10. to restore dignity and quality to work in the public system: this is indeed the first and most crucial point where the same ANAAO with Di Silverio has made another contribution recently here at QS.

We will now witness an election campaign in which everyone will emphasize the importance of the public health system and the centrality of the adequate treatment of the staff who work there. Calenda and Bonino have already started making statements to this effect (and they are absolutely serious numbers) as reported here on QS.

Unfortunately, if the political will does not translate into coherent actions, the goodness of the principles (which, by the way, will be shared by all) will not improve either the assistance to the citizens or the satisfaction of the operators. And they will not improve even if we limit ourselves to the simple compression of the role of private individuals, which, in the absence of other coherent measures, will only reduce the coverage of the essential levels of assistance.

Claudio Maria Maffei

27 July 2022
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