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In the last few months, there
has been a lot of talking about public and private health. To tell the
truth, the Minister of Health, Mrs. Rosi Bindi, only seems to consider
public health, having a strong dislike for the word "private",
to which she seems to be allergic.
In
the framework of the Italian economy, there are some distinct differences
between the management and administration of a service that may be public
and private at the same time: all over the world there are excellent
public services entrusted to public management.
Moreover,
the Ministry of Health has to deal with a range of services where the
difference between public and private is very indefinite. There are
even large hospitals that are efficiently managed by private bodies,
and there are small operational structures that are managed by the public
sector.
Then in the health sector there is also a third way,
rather anomalous in the field of economy, which is that of services
carried out within the national health service. In practice, this means
that there are private structures that work with public funds.
Originally,
this third way was set up to prevent insured people covered by the health
insurance service from spending their money: the service provided for
paying the doctor or the structure operating within the national health
service the amount for the services offered to its insured party. With
the National Health Service, which was set up in a context of nationalization
of all services linked to health protection, the concept of health insurance
was virtually abolished and thus all kinds of health insurance funds
and institutes were absorbed and monopolized by a single cumbersome
public service that in the end distorted the original concept of public
and private sectors.
Furthermore,
as far as the agreement between private and public sectors is concerned,
the double relationship (patient-doctor), with a third payer (Sickness
Funds), has changed into a hybrid relationship between public and private,
between services and panel doctor that in practice offers at reduced
price and at its expenses a type of service that belongs neither to
the employee sector (public) nor to the profession field (private).
The
result, which the recent flu epidemic amplified even more, is visible
to everybody.
In
fact, instead of granting its beneficiaries an annual fee for the services
that could be necessary during the year, in practice the national health
service offers them all services that can be covered by a predetermined
lump sum. Thus, as long as home visits are included in a lump-sum rate,
it will not be possible to grant efficient home care.
The
problem of a nationalized service like public health is that of being
able to control, mainly from the financial viewpoint, the free access
to the family doctor on behalf of patients, on the basis of the more
and more frequent needs linked to modern society. And then one comes
up with a per capita lump sum that is paid to the doctor independently
of whether the patient has benefited from the services of that doctor
or whether this is ready to carry out with care all the services he
will be required to provide.
Obviously,
at this point it should be decided, with no hesitation, what should
be reserved for the public sector and what should be left to the private
sector.
It
is necessary to clear up the situation of the Italian public health,
starting from the assumption that it is not important whether one turns
to the public or the private sector: all the services provided should
be paid what they are really worth, no matter if it is general medicine,
specialist medicine or hospital medicine.
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Mensile di scienza medica e attualita`