We are back to talking about Health Reform. And it would seem that a draft of reform is being developed, according to what has been possible to learn from the media, which will particularly affect the role of family doctors.
English: If we look closely, more than twenty years have passed since the last major health reform, the one called Reform -Ter or Bindi Decree pursuant to Law number 229 of 1999, which, in the intentions of the Legislator of the time, should have been the natural completion of the process of organization and rationalization useful for guaranteeing a national health service as efficient and effective as possible. The key points of that Reform, among many, were identifiable, roughly, and to put it simply, in the so-called "redefinition" of the founding principles of the plan for the financial sustainability of the entire system, paying particular attention to the profile of the choices regarding the use of resources. At the time, and in particular, there was talk of medicine based on scientific evidence. Translated into money, additional health services could not be guaranteed when there was a treatment that, with equal results, was cheaper. But every reform, with good approximation, and however good, seems to be a product of its own time and, probably necessarily, would seem to be affected not only, and indeed, by the passing of time, but also by changes in the social fabric of reference and its contingent needs.
In the post-pandemic current situation, there seems to have been a significant shortage in the number of so-called general practitioners, with respect to whom, according to the news of the last few days, a sort of reform is being developed that could well affect their very professional classification. Freelancers or ASL employees? This would be the question of the moment. What are the pros and cons? The usefulness of each reform should be measured against the usefulness of its founding assumption. Up to now, family doctors have been, and are, classifiable as freelancers contracted with the Health System. So, up to this point, no quaestio. It would then be a question of understanding, for the purposes of the reform that seems to be being developed (the conditional is a must), whether the current shortage in numerical terms of family doctors is due to their current professional classification, or to other factors, perhaps to be investigated more thoroughly before undertaking any initiative. To put it differently: it would be useful to investigate whether the very fact of making family doctors effectively dependent on the National Health Service on a formal and substantial level can be considered a suitable decisive measure to guarantee the citizen the continuity and effectiveness of the service to be provided. To put it again differently: would such a different framework really be decisive, or rather, useful to guarantee the numerical coverage of family doctors throughout the national territory also in consideration of the geographical specificities of the same?
Let's be clear: in a territory such as Sardinia, with all the critical issues of its internal areas and the difficulties in the transport system, would it be a decisive reform suitable for guaranteeing the service in terms of proximity of the services provided?
At first glance, if some would seem to argue that the different professional classification could negatively impact the doctor-patient relationship of trust that would be affected by the principle of rotation of healthcare personnel, others, instead, would be inclined to believe that the new professional classification could guarantee greater integration between hospitals and the territory in terms of service provision as well as greater protection on the work level for the professional figures involved. There would still seem to be many doubts, and probably the effectiveness of a reform of this consistency could be directly proportional to the individual regional specificities and the needs of the reference territory, different by their very nature and in which the figure of the family doctor must remain central.
The health service must be tailored to the patient, serve his needs, and therefore must be calibrated to the territory of strict reference in order to guarantee the uniformity of the service.
Giuseppina Di Salvatore – Lawyer, Nuoro
