A great resonance has had these days the precautionary arrest of five consultants of the San Raffaele Hospital of Milan. But what could have ever done these famous personages, well-known over the entire scientific world to deserve a so serious punishment? Here I don't want to enter into details about the justness or not of a norm foreseeing the arrest of any citizen belonging to the Italian Republic before having even listen to him, reserving the magistrate to listen the version of the charged for a crime only after all the world is already well informed about he has put in jail. A thing seems rather sure and it concerns the argument risen with regard to the right or wrong application by the Hospital, where those physicians worked, of the set of rules enforcing the Government Regulations Decree In truth in Italy this health services forfeit payment system carried out in Hospitals, whether public or private, has a long story, having been introduced in our country only in 1996, or more exactly on January 1st 1996. It is introduced a revolutionary set of rules concerning payment of services, that from this moment carried out by a new methodological setting out so it becomes very important the diagnosis - service - payment connection according to the fact the service has been catered for at 23.59 on 31.12.95 or at 00:01 on 01.01.96. Let's see instead what happens there where it is decided the destine of subordinates: at 12 o'clock p.m. on 31.12.95 the Law has been passed starting from 01.01.96, but Parliament is closed and parliamentarians are rightly uncorking a bottle of champagne to toast the new year. If all goes on right (Italian Postal services allowing it) the copy of the Official Gazette will be in the several towns State libraries on about January 15th. Finally now the copy of the Official Gazette, carrying the bomb-Law already in force since 15 years, is on the desk of the structure Administrator. This point the matter is the setting out of norms to make them operative as soon as possible and that involves, besides the administrator, also all the administrative offices from the administrative Reception up to the account department, all Hospital wards, from the operating theatre reception to the analysis laboratories, the several radiology wards, Physical therapies and rehabilitation, all heads of hospital wards, physicians, departments' secretaries. If all that were not enough, since all is already computerized, it must reviewed all the data processing system that will provide to survey, process and lay out all the data required by the new organization. Clearly, to modify the informatics procedures it will be indispensable to make skilled technicians carrying out a macroanalysis, a microanalysis and a reediting of all Hospitals informatics programs. This last operation must be first in order to the fact the whole Government Regulations Decree enforcement is linked to the code number going with patients along all phases of the stay in hospital since the admission till discharging or death. Minimum time for the study, elaboration and installation of the new informatics procedures: six months. This time it starts-off the work for capacitating the attached administrative personnel and informing and making aware the whole sanitary personnel about the new procedures to be applied retroactively since January 1st 1996. Unfortunately running a Hospital must be warranted for 23 hours a day and for 365 a year, it requires turn over and it takes several months to get widespread information and acknowledgement of the new provisions. Meanwhile all 1996 would pass and the new system, even if taken-off officially, has not been settled yet. The Minister of Health herself has publicly admitted that it would have taken three years to focalize the new set of rules and furthermore she has officially acknowledged that it must have been reviewed to make it work well (that it has not been done yet up to today). In exchange for, they have enabled to watch at the huge bulk of work carried out over these three years looking for crimes. It would have been opportune that the Health Service Organs had controlled since the beginning the right application of the innovative payment system, going on site to give the required settlements to D.R. G. This way they would have detected on site the required modifications to be brought to the system providing in good time their correction, without criminalizing anyone and making nobody be criminalized, even for they hold the purse strings and they could easily regulate the outlay flows they did not deem correct.

 

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