As always, we must start from the numbers, from the data to have a clearer idea of what is happening and what we can do. In the period from 2019 to 2020, some preliminary estimates show a 1.2-year decrease in life expectancy, from 83.5 to 82.4 years. Part of the causes are attributable to Covid, but we must not ignore another important fact.

And that is that in 2021 during the pandemic 23.5% of the population gave up treatment . This is also because the hospitals, all of them, have drastically reduced their normal activities and an enormous mass of citizens has been forcibly forced to resort to private health care which has grown hand in hand. In fact, about 23% of total per capita health expenditure was made up of what in technical terms is called “out-of-pocket”, that is, paid out of one's own pocket.

Total pharmaceutical expenditure was 32.2 billion, of which only 22.3 billion were paid by the National Health Service. We must increasingly bear in mind that consumption increases with increasing age, in particular the population over 64 absorbs about 70% of health expenditure.

In recent years we have witnessed a transformation of our healthcare. A drastic reduction in the public healthcare offer linked to the “closures” due to Covid has been accompanied and developed by a private offer not only of accredited private structures, but of specialists both individually and in multi-specialized studies. Not only that, but most hospital doctors are and can do freelance and are present with their rates on the Internet sites of the hospitals where they work. Too bad that those looking for a competent doctor for their pathology do not have the opportunity to know the skills and preparation of the doctor they can choose.

The choice is therefore conditioned by the cost of the rate, assuming that the higher it is, the better the competence and preparation. In societies with more advanced health systems, patients can write an email to the hospital indicating their ailments and receive a confirmation with the name and availability of doctors who are experts in that pathology.

The other aspect of public health privatization is that of hired doctors.

In the past, working in the National Health Service was a strong aspiration. Covid and not only has changed these aspirations. In 2021 there were 2,886 voluntary layoffs, 39% more than in 2020. Putting this trend together with retirements, the future of public health is bleak. Rented doctors come to the rescue, but their abilities are never known. They are guaranteed by cooperatives. Supply and demand intersect. Co-operatives place their ads on their sites or on social networks. Then there are specific sites to which doctors sign up and wait for the right token. In Sardinia for a 12-hour shift in the emergency room the doctor is entitled to a token of 600 euros plus accommodation . With other cooperatives you can earn up to 3,800 euros in 48 hours.

Faced with the crisis of our health service, not only regional policy cannot place the blame on previous administrations. In these 20 years the defaults have been shared among all. What to do? Give a modern structure to the whole system. Enough with the Primaries in charge, selective competitions should be announced at the hospital level based on merit, that is, on their skills . The preparation of doctors is not assessed by the educational credits. New organizational models are needed to achieve better results with fewer staff. All hospitals must have a structure that deals with the digitization of medical records and the collection of flows of what is needed in clinical practice. A change can be made. To begin.

Antonio Barracca

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