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Undersigned
on March 9th 2000, by governments and medical union trades, the new
collective agreement for the discipline of the general medicine physicians,
at the end of June 2000 has not be yet issued on the Official Bulletin
so that to make it possible to view it by the technical bodies of the
Regions and ASL in order to study the concrete application. The matter
is not that the three-year agreement cannot be applied for the effective
three years of its duration, since the convention was undersigned after
as far three years of negotiations and starting from 1/1/1998, if the
publication will still delayed, it will end going on force few weeks
before its expiring, foreseen on December 31st 2000. Naturally, meanwhile
there will be the interested physicians that will have already retired,
there'll be new norms that will be introduced just the day of the final
expiring, there will balances for the due payments according to the
new agreement that this point will be paid to inheritors. Don't mention
then the "preliminary declaration ". Three pages of purposes summarized
in as far as 29 commas and paragraphs, talking about reorganization
of the Service, integration of the figure of the physician into the
organization, valorisation of his work, continuity, globality, emergency,
programmed assistance and so many other things that must be put in act
when the Norm to enforce them will not exist anymore since it has already
expired. In a civil country all that would not have any meaning. Usually
agreements all over the world have a starting date (few or much) later
than the stipulation date, but never before. At the most it can be done
an act of indemnity for the bygone, but never dictate conditions that
must be respected in a date before the stipulation of the agreement.
But in Italy our politicians discovered the institution of the prorogatio
that in fact allows delaying infinitively situations that fit them.
But to whom would it fit this situation of steady illegitimacy that
allow stipulating economic agreements that has only a retroactive value
for services already performed? Surely not to physicians that, living
this contractual uncertainty situation, only draw damage. Neither to
physicians that aspire to enter and that do not know which norms they
will refer to in order to be put in the classification list. Don't remember
that the national health system involves the whole Italian population;
inclusive resident immigrates or registered by police. The same for
the physicians that after graduating cannot practice their profession
for the citizens assisted by the Service (the whole population) but
by accessing to the Convention. But what does the agreement, born dead,
foresees for the access to the classification list? Even here the agreement
foresees an entire page with 9 paragraphs of bureaucratic norms for
submitting the application, and other two with 25 commas for the evaluation
of the qualifications and other page with 8 paragraphs about the incompatibility
and other two pages with as far as 15 paragraphs about the optimum ratio
that cannot go below a physician per 1000 inhabitants. If all that were
not enough, it's important to know that this Convention in force from
1/1/98 and expiring on 31/12/2000, foresees the submitting of the application
for the admittance in the classification list for the following year
within January 31st. That means that the first physicians that can submit
the application by this new Disposal must do it within January 31st
2001 to access the classification list, worthy for the year 2002, by
performing disposals expired two years before. In return for, the agreement
foresees the possibility to constitute in cooperatives, as it occurs
for the food stores and maybe also to adhere to the cooperative consortia
where surely there'll be some union officers or some politicians, skilled
in cooperatives, seated in the armchair waiting for the physicians that
will want to adhere to the initiative. What remains of the professional
freedom of the physician in an agreement that goes on walking down step
by step, is unknown. Surely all that does not occur for a lawyer, an
engineer, an architect, a commercial law expert, an accountant, a surveyor,
a biologist and so on, that to practice their profession have only the
duty to be enrolled in their professional order. Evidently the other
professional orders have not abdicated their prerogatives to safeguard
their own rights. On the other side, in an as far as 161 pages agreement,
we could find so many other goodies, but what we want to underline is
the fact that these conventions are becoming a kind of Summa Ideologica
wherein is transferred a set of theoretical principles about the health
assistance that have nothing to do with the normal work relationship
of a general medicine physician. At the end there must be a simple three-parties
economic agreement where there's a client that applies for a professional
physician that works in his studio lying over a relationship, that for
the Ministry of Health is of Convention, while for the Finance Ministry
is a professional one, for whom there's a third payer that must pay
the service in name of and on account of a client, by fixing, on agreement,
the fees of services. But it would be too much simple: I believe that
in Italy, if the orchestra does not change, the music will be always
the same.
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