The economic data are all too clear in their rawness. According to what the reports of the Cergas SDA – Bocconi and the Crea Sanità report, they would miss at least 40-50 billion euros to support public health. But this does not mean that one cannot think of a sort of “new deal” that can somehow redesign the NHS on a national scale, keeping the principles of Universality, equity, solidarity and sustainability of the system.
What to do? A possible design response, at least in the form of Roadmap, comes from a document signed by over 40 scholars of the major Italian research and universities and experts in the sector. The analysis examines critical issues, their possible causes and solutions for the reform of the NHS. The text of the document can be consulted on the sites of the Cergas – SDA Bocconi, creates healthcare, MES laboratory of the Sant’Anna di Pisa and according to Welfare.
What emerges from work
The document proposes a series of programmatic observations and aims to propose essential elements for one SSN reform that is based on the national level of action, preserving the principles of universality, equity, solidarity and sustainability of the system. In this sense it represents a real Valorial paperdeveloped to encourage the debate and public engagement and to facilitate a deep collective discussion process for the start of a Radical and lasting change.
The document, the result of a multidisciplinary work, starts from an analysis of the critical issues of the current health system and proposes a vision to face the challenges of the future so that the right to health protection enunciated by article 32 of the Constitution is guaranteed in substantial and not only formal terms.
Among the main themes, the urgent need to reduce territorial inequalities, guarantee fair access to quality services and promote a sustainable use of available resources.
Some causes of the suffering of the NHS
Without limiting yourself to the economic fact only, the analysis of scholars tries to list the steps that today create difficulties in the system. Substantially at the base of everything there is still a vision that first places the approach to acute pathologiesin a world that instead proposes the chronicity challenge. In short, there would be an offer of services misalline Compared to the growing weight of chronicity (38% of the population). The professional paths of the NHS are still connected mainly to the care of acute patients.
Second critical point: the levels of public funding are not consistent with the Lea, a phenomenon accentuated by their failure to revise, as required by the legislation. The need for transparency in fears of function of function of health protectionwith activities for the production of services with widespread gaps and leopard stain in taking charge and in the paths of chronic/fragile and non -fragile patients.
Still. It is not possible to overcome the logic of the “silos” for assistance setting or by matter/discipline nor remedy a strategy that sees the dominant dominant health health and not initiative Which, on the one hand, multiplies the performances that are not always appropriate and, on the other, cannot identify unexpressed needs.
To act as a hat to these problems, substantial are observed inadequateness In vertical interinstitutional governance with limited investment in the role, functions and responsibilities of essential middle management in large companies.
Finally, the document reports a failure to coordinate between planning the training of health personnel and the needs of the system, with an implicit and often unaware selection of the priorities and above all with one little use of health and administrative data Available, which instead could help substantially inform the processes of programming and evaluation of public health.
The fifteen principles for a reform
Adjusting the future of the NHS means identifying actions that can contribute to maintaining and developing it. Here, in summary, the key points of the document.
- Universalism. The principle of universalism as a guarantee of protection extended to the whole population must be reconfirmed. This principle must be declined today as universalism proportional to the nature and specificity of individual and population needs, as well as to the characteristics of individuals and communities.
- Equity. Different answers for different needs must be offered. It must be divided into size: geographical, understood in terms of equal opportunities for access to predetermined quality services; in the health results that can imply a “unequal treatment, but proportional to health needs, but also to the characteristics of citizens”; as a guarantee that the rights declared are then concretely due.
- Promise what can be maintained. It should be ensured that everything that is prescribed in the NHSn regime is actually and automatically booked within the time required by the therapeutic indication itself.
- Globality. The NHS must focus on the production of direct prevention, diagnosis, care and rehabilitation services and integration with social and social and health institutions, on the impact on the health of economic policies and the various sectors.
- Centrality of the person. The centrality of people is divided into three dimensions: humanization, participation and empowerment. Humanization implies respect for dignity and personalization of services. The participation of citizens is essential to promote pacts with communities and must be enhanced with new interaction channels and programming focused on the rights and the quality of services. Empowerment means giving people useful knowledge to generate adult expectations, fundamental for adherence to therapies and correct lifestyles.
- Efficiency. It must be focused on the optimization of the cost-benefit ratio, crucial to guarantee a sustainable and fair NHS. In a context of limited resources, efficiency takes on an ethical dimension, aimed at maximizing health and social inclusion.
- Effectiveness. It is necessary to focus on clinical effectiveness, with the application of scientific evidence to maximize the health results, the satisfaction of patients, guaranteeing services that respect the expectations and rights of citizens, and holistic qualities, which consider clinical, welfare and relational aspects. And it is necessary to evaluate and measure.
- Taking charge and health health care. The NHS must recruit, inform, involve, educate, and monitor the person in his different stages of life and taking into account his clinical history. Taking charge of the person with chronicity guarantees that the patient knows his integrated welfare plan (PAI) in time, helping to reduce the health consumerism deriving from the multiplication of the services not coordinated.
- Government of horizontal interdependencies. Complex and increasingly integrated health needs require a unitary government. On the horizontal level, it is necessary to reunite governance and access criteria to improve the efficiency and integration of health, social and health and social services within the welfare system.
- Government of vertical interdependencies. The State-Regions and regions-regions-health supplies must be reclaimed. In the first case it is necessary to redefine the distribution of skills, improve the implementation capacity of the policies and the transfer of knowledge/competences and regulate the levels of regional autonomy based on the level of performance. In the second case, the principle of autonomy/liability between regional group leaders and companies must be regulated in a coherent and clear way.
- Simplify the control system. The control system and is to be concentrated in no more than three institutions (regions, ministry and administrative control bodies). Two types of requests for information must be coordinated: those of central bodies aimed at verifying and monitoring compliance with national standards and criteria relevant to the regions and for the central level.
- Co-programming models. To ensure a fair health system, the National Health Service (SSN) must: differentiate its functions between the management of the public system, the client to accredited private dispensers and regulation of those not credited, and establish a specific financing for assistance to the elderly non -elderly self -sufficient. In addition, it is necessary to adopt a program of co-planning involving public and private entities both in the loan and in the provision of services.
- Autonomy of corporate management. The balance between autonomy and responsibility must guide the management of the NHS companies. It is necessary to expand the autonomy of management, allowing general directors to choose their collaborators and customize contracts, as well as freely managing the production factors based on the results obtained. The management with personalized objectives, simplification of controls and responsibilities, and salaries adequate to the size of the companies must then be empowered. It is important to clarify the functions of companies and define institutional and legal solutions that the regions can adopt according to the degree of autonomy granted.
- Make the NHS fly to economic development. Assistance, research and the life supply chain are interconnected and their collaboration can generate value for the country. The NHS must also have the contribution to research, innovation and development policies of the science of life science, overcoming silos policies. It is therefore necessary to define strategic development priorities of the NHS and the industrial sector, to define the country’s areas of competitive advantage to be enhanced and organized the NHS as a research platform to attract global funding.
- Innovation. It is necessary to develop a strategy that exploits the benefits of innovation, in particular of the use of artificial intelligence and quantum computing, and also addresses development by involving businesses as co-producing innovation, oriented towards patients’ needs. Health Technology Assessment models and methods must be offered in a strategic perspective for the country.