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In
recent years, federalism has taken shape to the point that more consideration
is now given to the Italian regions. In the health sector, progress
is also being made along these lines with countless national and regional
laws granting responsibility for public health to the regions. As far
as general medicine is concerned, a succession of conventions over the
past three years has shifted the onus of national agreements to the
regional authorities. It is true that negotiations to renew contracts
take place in Rome, but now doctors no longer find themselves face to
face with the Ministry for Health but regional authorities. The various
regional health councillors nominate a delegation of councillors with
a president, also appointed by the regions, who conducts negotiations
in the name and on behalf of the twenty Italian regions plus the provinces
of Trent and Bolzano. The last two agreements to have been stipulated
included additional regional agreements to be stipulated at local level.
Calling the respective parties and finding an agreement can prove to
be an inordinately long process. This is undoubtedly the reason why
deadlines and dates have now become an optional feature. The result?
Official Journal n°230 of 2nd October 2000 published a collective national
agreement governing relations with general practitioners with effect
from 1st January 1998 and expiring on 31st December 2000. Hence, a convention
with a validity of three years is decreed exactly three months before
the end of the term. Times change for sure and the author of this article
has himself taken part in negotiations for conventions governing general
medicine first with INAM, ENPAS, INADEL, then with the Ministry representing
SAUB, then with the Minister again but this time representing USL, then
yet again with the Ministry representing the regions and finally with
regional delegations. Without a shadow of doubt, things have gone from
bad to worse: the timescale is longer and the contents of the agreements
themselves are encumbered with laws and bureaucratic cavils that effectively
deprive doctors of professionalism so that patients are faced with a
more bureaucratic, less sympathetic medic. At this stage, in view of
the new legislature that places even greater emphasis on federalism,
we may well question ourselves on the point of a national agreement
for general medicine. Since responsibility for health has now been handed
to the regions, since negotiations must be conducted by the regions
and then integrated with regional agreements, it would seem more logical
for each region to stipulate a regional agreement locally, without even
troubling the woolly inter-regional authorities in Rome. This would
undoubtedly accelerate negotiations and agreements and make it possible
to stick to deadlines so that doctors are no longer forced to take important
decisions retrospectively. Above all, it would ensure that appropriate
assistance is given to citizens in a particular region since their needs
do not necessarily correspond with the needs of citizens in another
region. It obvious that local authorities know more about the needs
of citizens and the best way to organise services than a central authority
where even the State seems to be distant, even though somehow or other,
it should know everything that goes on. At this stage, there is little
point in discussing the merits of the type of federalism that needs
to be introduced in Italy. What cannot be tolerated is the current hybrid
situation whereby merely for political reasons, laws are passed and
the State fails to shoulder its responsibilities for fear of being accused
of anti-federalism, yet fails to delegate power federally. A similar
situation can only damage doctors and lead to poor medical assistance
for citizens and disorganised health authorities.
(traduzione
Interpres sas-Giussano)
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