Here’s how the Draghi government will reform healthcare with the Recovery Plan
What emerges from the draft of the PNRR prepared by the Draghi government on health. Enrico Martial's article
The National Recovery and Resilience Plan (the Pnrr, or Recovery plan, 196.5 billion at 2019 prices) will affect the health system with a series of reforms: a different articulation of health and social-health care in the area, digitalisation and technological equipment, human capital with research and training.
Since Draghi's NRP connects reforms and investments , the analysis starts with the problems to be solved. The first was highlighted by the pandemic, which showed the greatest criticalities precisely in health management in the area.
There are also two other weaknesses: on the one hand the differences between Regions and between territories, such as between urban and inland areas, and on the other hand the disconnection between hospital services, local services and social services.
As a corollary to these general problems to be solved, we must add the fragility of local health services and the poor capacity for prevention, also with respect to environmental and climatic risks, including pollution.
It is not a very black picture: the universal health system (Beveridge) seemed better to respond to the Covid crisis, life expectancy in Italy is higher and compared to the OECD averages, even with relatively limited health expenditure.
To simplify, health workers are quite smart, in the frailties there are also excellent structures, research is carried out, although more could be done.
The data confirm the regional and territorial disparities: infant mortality (Italy has the lowest rates on a global scale) measures 2.24 in the north-east and 3.70 in the islands (data from the Pnrr draft seem provisional) the hope of life in Campania reaches 81.4 years compared to 84 years in Trento, air quality negatively affects the Po Valley and other cities, with about 30 thousand deaths from particulate matter, 7% of all deaths, excluding accidents. Furthermore, home care is weak, offered to 4% of the elderly compared to the OECD average of 6%.
The draft of the Pnrr (in English) of 11 March responds to the three main problems (lack of territorial articulation, differences between regions and territories, disconnection between hospital, local and social levels) and to the corollary ones with a reform of the territorial assistance model. The general principle is that of equal access to health and social services, even if the regulatory and legislative procedures to be developed are not read very well in the Pnrr, which are also registered in the Health Plan and in the State-Regions agreements. In the Pnrr it is rather the investments that clarify the path.
It starts with "home care" (homecare), to be strengthened, affecting 282 thousand people and operators, with an affected population of 14 million. 575 centers for home care are created, with technological devices for operators, telemedicine technologies for patients and for the digital solutions of the ASL that connect to them.
It continues with the establishment of 2,575 Community Health Homes open all day, where you can consult the general practitioner and a nurse, where you go for a malaise or a small accident, to schedule a test. The outpatient clinic model must be overcome, we pass from the centrality of performance to that of the person and the community. The Houses also deal with chronic diseases, with shared and supervised paths. They are technologically structured and equipped with the appropriate skills. Being in the area, notes the NRP, produces better, more efficient and less expensive services than concentrating on hospital and similar treatments.
The “Casa della Salute” has been present in the national debate for years, it had its first implementations and today it is a significant and considered successful reality in various Regions, even if it is not perceived as a national strategy. Lazio had 48 Health Homes in the pipeline in the 2014-2020 European programming, and 22 are now active , while about seventy are in operation in Tuscany, and for example 22 in the province of Bologna alone. Not all Regions have followed this model, so a survey of the existing Health Homes, of the structures to be converted and of those to be done from scratch, is expected by the first quarter of 2022. The works and institutional program agreements with the Regions will follow, with the completion of the operation in 2026.
Finally, the territorialization of the health service provides for the creation of 753 "Community Hospitals" aimed at reducing hospitalizations in the general hospital, with nursing support and continuous medical assistance, for people who come from the RSA, from their home or are from little discharged from a general hospital but still in need of treatment. They are an intermediate structure between Integrated Home Care (ADI) and the hospital, and they are nothing new. The first State-Regions agreement dates back to 10 July 2014, and the minimum requirements (technological, structural) were approved by a new agreement on 20 January 2020 .
Registered in the Pnrr and in the agreements, it is a reform from above, which aims to make uniform the performance, the LEA, for all citizens, in urban centers and valleys or in the countryside, and not only between the north and south. The impact of the connection between reforms and investments will also have effects on the Lombard system, which is precisely the most diverse, centered more on performance than on the person, more on the large hospital than on the territory, as has been well seen during the health emergency. The PNRR, taking the money with it, accelerates a national process of modernization and standardization, with more homogeneous expected effects.
Of the entire Pnrr of 196.5 billion, and of the quota assigned to the Health Mission of 18.1 billion (net of funds for other missions concerning health), the expenditure for Component 1 (M6C1) " Proximity networks , structures and telemedicine for local health care ”worth 7 billion euros. There are 4 billion for Healthcare Homes, 2 billion for Community Hospitals, 1 billion for home care. They are distributed over 6 years and therefore, on closer inspection, there are not many, so it is assumed that these issues will probably be partly financed (as has already been) also by the Regional Operational Programs (POR) and by state funds.
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/come-il-governo-draghi-riformera-la-sanita/ on Tue, 16 Mar 2021 09:41:44 +0000.