An economic incentive for general practitioners who reduce the number of specialist visits and tests considered inappropriate. This is the measure introduced by the Modena Local Health Authority, signed with general practitioners through Fimmg. It is already raising the debate between enthusiasm and strong doubts.
The 1,800 euro bonus
The mechanism is simple: for each patient assisted, the doctor will receive 1.2 euros per year if he manages to contain the prescriptions for certain services within a threshold of approximately 25% less than 2024 levels.
Considering that a medical practice has an average of 1,500 patients, the maximum premium for the doctor could reach 1,800 euros per year.
There are twelve services involved and include visits in areas such as dermatology, gastroenterology, ophthalmology, urology, and tests such as CT scans, magnetic resonance imaging, gastroscopies and colonoscopies.
The statement from the Local Health Authority
The objective declared by the Local Health Authority is not an indiscriminate reduction, but a push towards greater “prescriptive appropriateness”. As explained by the general director, Claudio Vagnini, the intent is
prescribe better for the right patients.
The initiative aims to make more efficient use of resources, encouraging doctors to prescribe only what is truly necessary, even when this means having to explain to a patient why a requested test is not essential.
The provision, defined by the DG as innovativehowever, according to Vagnini himself, rules:
a very difficult part of the doctor-patient relationship.
At the center of the resolution, already adopted in some provinces of Veneto, are general practitioners who often find themselves filling out the famous red prescription at the request of patients after the patients have turned to specialists.
However, according to the provincial secretary of Fimmg and historic general practitioner of Pavullo Dante Cintori, those visits are not always necessary
There is no need to have a dermatological examination every year if there are no potentially malignant moles. Or to do three CT scans of a cancer patient in the last month of life. These are just examples to go into detail and better understand what we are talking about. No one denies patients visits when they are necessary. Indeed, in Modena we have an emergency catalog that works very well, in these cases we can guarantee a visit within 10 days.
Controversy from the Region
Not all doctors, however, welcomed the agreement. Some express skepticism, pointing out that many factors that influence prescriptions, such as the indications of specialists or the insistence of patients, are outside their direct control. Not to mention that in Italy little is already spent on prevention.
The controversy also reached the Emilia-Romagna Region, with a question from Fratelli d’Italia, first signed by Annalisa Arletti.
The party asks the Council:
careful reflection (and clarification) if it intends to extend this model to other healthcare companies.
The most critical point raised by the opposition concerns the relationship of trust between doctor and patient. As Annalisa Arletti underlined:
The provision risks undermining the citizen’s trust in the doctor who, in the eyes of the patient, could make decisions to go in the direction of receiving the economic incentive.
The news arrives just after the publication of Agenas data on health tourism in Emilia-Romagna, which has become the first arrival region for patients from the entire peninsula.
