This is how Italian healthcare will change. Sileri speaks
The Undersecretary of Health, Pierpaolo Sileri, explains where the resources of the NRP will go: strengthening of the territorial structures, massive use of technology, teamwork around the patient. And more prevention.
Start Magazine conversation with Pierpaolo Sileri, Italian surgeon and academic, from 1 March 2021 undersecretary of state at the Ministry of Health in the Draghi government and previously, for two years, deputy minister at the same department in the second Conte government.
Covid-19 has brought to light too many inefficiencies of the Italian health system. What has this pandemic taught us?
The pandemic has certainly highlighted the criticalities of a territorial assistance that for too long has suffered from an imbalance towards the hospital. Our health care was already suffering, due to the numerous cuts suffered over the last few years. The pandemic has taught us that we must necessarily start again from prevention and primary care in order to focus on taking care of proximity, integrated as much as possible between hospital and home, between local and social services, to respond to complex health needs, chronic conditions , to the frailties of the elderly. The pandemic has also brought to light the structural shortcomings of the healthcare system in the technological field, regional inequalities, uneven access to services in terms of timing and complementarity of the offer. There has been talk for a long time about telemedicine, about digital health, but only in recent years, and even more in these months of health emergency, have we really understood the potential of remote assistance, the possibility of treatment and medical dialogue. patient even at a distance, of the indispensability of the continuity of health and social-health support, identifying the home as the first place of care.
According to the Gimbe Foundation , between cuts and lower revenues, the national health system has lost 37 billion euros in the last ten years (2010-2019). A significant figure, the consequences of which have affected our response to the pandemic. What are the government's plans to re-finance the health system?
The National Recovery and Resilience Plan (PNRR) allocates 18.5 billion to the health sector. It therefore represents a great opportunity to make those necessary changes to our national health system. For the mission envisaged by the PNRR, called “Proximity networks, structures and telemedicine for territorial health care”, an expenditure of 7 billion euros is expected. Then there are around 4 billion euros for health care homes, 2 billion euros for community hospitals and 1 billion euros for home care.
What are the health care reforms planned in the National Recovery and Resilience Plan?
It starts with "home care" (homecare) which will be strengthened in consideration of the fact that it affects 282 thousand people and operators. Therefore 575 centers for home care will be created, with technological devices for operators, telemedicine technologies for patients and for the digital solutions of the ASLs that connect to them. We will continue 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 houses also deal with chronic diseases, with shared and supervised paths. They are technologically structured and equipped with the appropriate skills to stay in the area, producing better, more efficient and less expensive services than concentrating in hospital and similar treatments. Finally, it is planned to create 753 community hospitals aimed at reducing admissions in the general hospital, with nursing support and continuous medical assistance, for people who come from the RSA, from their home or have recently discharged from a type hospital. general but still need attention. They are an intermediate structure between Integrated Home Care (ADI) and the hospital, and they are nothing new.
In recent months, local medicine has been absent. How does the government intend to enhance this aspect of health?
It is true, the pandemic has brought out various critical issues regarding territorial medicine. We need to bring care closer to patients, especially the most fragile ones. In the PNRR explicit reference is made to the elderly and non self-sufficient population, for which specific measures have been devised that favor the provision of services in the area. In this process it will be crucial to enhance the existing territorial structures such as community houses, which the Italian plan of the Next Generation Eu plans to bring to 1,288 in 2026. But it will be equally functional to improve all the places in which to privilege primary care, interventions low intensity clinical treatment, the treatment of post-acute conditions, with the double advantage of relieving hospital structures and emergency rooms and intervening more extensively and being close to the patient. Community hospitals will also be able to contribute to optimizing the proximity network, as well as the development of service pharmacies, especially in the most geographically disadvantaged contexts. For a territorial welfare that is truly in step with the times and in line with the health needs of citizens, an incisive reform will be necessary. It is a question of building an organizational model based on the “continuum of care”, all the more necessary for chronic and elderly patients, which provides for a coordinated team game between all the subjects assigned to the provision of services to the individual.
(Extract from an interview published in the latest issue of Start Magazine )
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/cosi-cambiera-la-sanita-italiana-parla-sileri/ on Sat, 28 Aug 2021 06:53:56 +0000.