From 2012 to 2022, “the use of fixed-term and temporary work in healthcare increased (from 2012 to 2022 a leap of +75.4%), and between 2015 and 2022, doctors’ salaries in the public administration decreased, in real terms, by 6.1%. Spending on fixed-term work, consultancy, collaboration, temporary work and other healthcare and social healthcare work services from the private sector amounted to 3.6 billion euros in 2022, with an increase of +66.4% compared to 2012”. These are some of the data presented today in the new Fnomceo-Censis Report, ‘The necessary paradigm shift in the Health Service: stop corporatization and return to the primacy of health’, presented this morning in Rome on the occasion of the conference ‘From the economy to the primacy of the person’, organized by Fnomceo itself, the National Federation of the Orders of Surgeons and Dentists.
The survey revealed that “9 out of 10 Italians now declare themselves convinced and concerned about the fact that the budget constraint has been the undisputed king of decisions regarding public spending on healthcare for too long”. A full 85% of our fellow countrymen believe it is appropriate to invest to make healthcare workers’ work more attractive. Precarious contracts and low wages are among the reasons that make it unattractive to remain in the National Health Service, so doctors and nurses are aiming to flee abroad. “The widespread experiences of Italians, of very long waiting lists for access to healthcare services in public or accredited private facilities, and the relative inevitable recourse to the purely private sector to shorten access times, or even those in congested facilities and services that are not in line with the expected quality standards, have dramatically made the social urgency of a different approach to healthcare current”, recalls Fnomceo in the commentary note to the survey.
“The need to intervene quickly by attracting new doctors and retaining those in service – he warns – is made more pressing by the fact that in the last 24 months, directly or through family members, 44.5% of Italians have experienced situations of overcrowding in hospital departments or health facilities”, as shown in the report. “These experiences are shared by 44.7% in the North-West, 39% in the North-East, 45.5% in the Center and 46.8% in the South-Islands. The multiplication of attacks on doctors – it is observed – is nothing other than the transformation of the doctor himself into the scapegoat of difficult contexts and possible performances not in line with expectations. According to 84.3% of Italians, attacks on doctors are an emergency that must be addressed with urgent and effective measures”.
From the Fnomceo-Censis research, very precise operational indications emerge: “Have more doctors with more rewarding salaries in line with those of a significant number of European countries; commit more public resources to expand the capacity to provide services and welcome patients in a health system struggling with the effects of the intense aging of the population”, underlines the National Federation of Medical Orders.
According to Fnomceo, “the substantial strengthening of public funding is a sort of unavoidable precondition, however it does not exhaust the range of problems to be addressed since, at this stage, what needs to be called into question is a fundamental, cultural and operational approach, which has been dominant in Italian healthcare for too long. It is the business-like approach – the federation notes – in which compliance with budget constraints prevails over evaluation criteria based on the necessity and appropriateness of services for the protection of citizens’ health and which, consequently, places the doctor in a subordinate position with respect to those responsible for the economic and financial aspects of healthcare”. However, the survey shows that “almost 92% of Italians consider healthcare for all a source of pride for the country and distinctiveness at an international level. Also for this reason, 83.6% explicitly declare that, after the traumatic experience of Covid, they expected many more resources and a more intense commitment to strengthen healthcare”.
In particular, “92.5% of those interviewed indicated that hiring doctors and nurses in the NHS is a supreme urgency. While 84.5% are convinced that having too many doctors on temporary contracts weakens healthcare. For 87.2%, it is therefore a priority to improve doctors’ working conditions and salaries, precisely because they consider them the most important resource in healthcare”. According to Filippo Anelli, president of Fnomceo, “a new paradigm is needed that puts the absolute centrality of health protection, prevention and follow-up first, introducing the principles of clinical governance in resource management and assigning doctors an essential role in these decision-making processes. We need to move from a model that sees the definition of resources as the first act, to then move on to maximizing profitability to try to achieve healthcare efficiency objectives, to one that instead defines health objectives and healthcare tools first and then identifies all the necessary resources”.
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