On
January 27 the constituent session pertaining the Bicameral Commission's
reform proposal opened at the House of Deputies. It did not introduce new
changes on the single subjects but it entailed the complete replacement
of the Republic's institution outlined by the Constitution in 1948 with
a new one. The Parliament's choices are likely to have some repercussions
in the future. These choices are so exacting that they need to be tackled
and approved with responsibility and avoid the conditioning of external
influences as well as of some corporations' interests. However, it is important
for the citizens to be informed correctly and to be able to follow the
debate's various phases in order to know what the constitutional changes
are and the consequences they might entail. In this delicate phase, the
Parliament must be entitled to be again the legislative power that is presently
being put into question. If the Parliament does not manage to avoid hindrances,
the democratic state would practically risk coming to an end.
Along with the constitutional
reforms, we continue to follow the works of the “Parliamentary Committee
of Inquiry on the Health Care System” chaired by Senator Tomassini. What
follow are the key points of last January's debate, based on the examination
of Bruno Sciotti (manager of the arrangements with welfare organisations)
pertaining the assessment of general medicine's performances and quality.
Sciotti began his speech by underscoring some pressing requests of the
World Health Organisation to health care's physicians. These requests were
added to the general guidelines of the 833 law about the programming method.
The legislative decrees number 502 and 517 introduced a control over the
quality of costs. As from 1995, attesting the quality and the quantity
of the services to be supplied by hospital and regional facilities became
compulsory.
When speaking of the past,
Sciotti mentioned some international recommendations like the Ljubljana's
card. The 1995 provisions defined the common information for the regions
necessary to know the specific indicators to benefit from health care services
and to underline the results achieved. Another decree (December 23, 1996)
involved the survey methods to get information on the companies' managerial
and economical activities. A considerable apparatus has then been developed
to better know what the resources of assistance sectors are. To illustrate
the problems linked to the assessment of performances and quality with
a specific reference to free-lance physicians having an arrangement with
the Local Health Care Centres, Sciotti spoke of the national collective
arrangements that finalize the guidelines on the quality of performances.
The provisions involved say that the compulsory updating should include
the quality of the performances. They also ask the professional commission
to establish criteria, standards and indicators to assess quality. As far
as the role of general practitioners today is concerned, Sciotti underscored
the need for a higher responsibility of these professionals. According
to these provisions, general practitioners will not limit their responsibilities
in the diagnostic and therapeutic fields: they will also have to assess
the opportunity cost within a context of prospective alternative jobs due
to the large resources available in order to organize productivity.
A 1994 ISTAT survey underlined
people's special likelihood towards general practitioners compared with
a very low satisfaction degree towards the national health care system
services.
At the end of Sciotti's
report, President Tomassini opened the debate. Senator Papini asked for
some explanations on some decrees. Senator Lauria wanted to know whether
the ISTAT survey was reliable; Sciotti and Tomassini himself confirmed
that other research focused on the relationship between doctors and patients
gave similar results. Senator Bernasconi maintained that the assessment
of performances and quality had not been exactly codified while tested
standards existed for the hospital and out-patients' fields. Sciotti claimed
again that the physicians' roles are the object of a deep evaluation and
innovation and that new objectives will be achieved with some regional
arrangements. Senator Monteleone complained about an excessive bureaucratisation
of the figure of general practitioners. He was supported by Senator Saracco
who maintained that their work should be protected and promoted. Senator
Mignone hoped that physicians could be helped by another professional having
technical skills to carry out bureaucratic tasks.
President Tomassini ultimately
agreed on the excessive bureaucratisation of general practitioners' activities.
He also agreed on the need to re-organise the system as a whole as well
as the need for physicians to be supported by proper professionals and
technical equipment that should help them organise their activities in
personal offices in the best possible way.
As far as we are concerned,
we perfectly agree with senators Monteleone and Saracco when they report
the bureaucratisation of the medical profession, but we honestly do not
understand Senator Mignone's hypothesis to place another not well defined
professional near general practitioners to ease their activities. Would
that be a secretary or what? Isn't this a way to increase the number of
employees in the public administration and thus to increase the bureaucracy
all intend to fight? Are these hypotheses or serious proposals? We hope
they will continue to be mere hypotheses.
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Membri della Commissione
parlamentare di inchiesta sul sistema sanitario
Sen.
Anna Maria Bernasconi
(Sinistra Democratica -
l'Ulivo)
Sen.
Francesco Bortolotto
(Verdi - l'Ulivo)
Sen.
Giovanni Bruni
(Rinnovamento italiano e
Indipendenti)
Sen.
Fulvio Camerini
(Sinistra Democratica -
l'Ulivo)
Sen.
Carla Castellani
(Alleanza Nazionale)
Sen.
Maria Grazia Daniele Galdi
(Sinistra Democratica -
l'Ulivo)
Sen.
Dino De Anna
(Forza Italia)
Sen.
Ferdinando Di Orio
(Sinistra Democratica -
l'Ulivo)
Sen.
Baldassarre Lauria
(Forza Italia)
Sen.
Severino Lavagnini
(Partito Popolare Italiano)
Sen.
Luigi Marino
(Rifondazione Comunista
-Progr.)
Sen.
Valentino Mignone
(Sinistra Democratica -
l'Ulivo)
Sen.
Antonino Monteleone
(Alleanza Nazionale)
Sen.
Bruno Napoli
(Centro Cristiano Democratico)
Sen.
Andrea Papini
(Gruppo misto)
Sen.
Enrico Pianetta
(Forza Italia)
Sen.
Fiorello Provera
(Lega Nord)
Sen.
Maurizio Ronconi
(Cristiano Democratici Uniti)
Sen.
Giovanni Saracco
(Sinistra Democratica -
l'Ulivo)
Sen.
Antonio Tomassini
(Forza Italia)
Sen.
Giancarlo Zilio
(Partito Popolare Italiano)
Funzionari del Ministero
della sanità
che la Commissione
ha già ascoltato
o ha
in programma di ascoltare
Dott.
Giorgio Verdecchia,
Direttore del Dipartimento
della programmazione
Dott.
Raffaele D'Ari,
Direttore del Dipartimento
delle professioni sanitarie, delle risorse umane e tecnologiche in sanità
e dell'assistenza sanitaria di competenza statale
Dott.
Fabrizio Oleari,
Direttore del Dipartimento
della prevenzione
Dott.
Zotta,
Direttore del Servizio per
la vigilanza sugli enti
Dott.
Bruno Sciotti,
Direttore del Servizio rapporti
convenzionali con il Servizio Sanitario Nazionale
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Italian
Mensile di scienza medica e attualita`
