Towards the elections. The health officials of the parties speak. Gemmato (FdI): “More resources for staff and to target family doctors and pharmacies on the territory”. Then the stop to the allies: “No to differentiated regionalism in health care”

by Giovanni Rodriquez

“We must not do what is foreseen by the NRP, with the money spent almost exclusively on facilities or equipment. We want to invest in healthcare professionals instead, this is the real urgency”. The Community Houses were also rejected: “There would remain a patchwork of healthcare, our intention is instead to invest in the existing and functioning network of general practitioners and pharmacies”. As for Covid, the aim is to sensitize people most at risk to vaccination but “no” to new obligations.

22 SEPT

Reviewing the NRP aiming at investing in health personnel, reviewing the reform of local health by focusing on pharmacies and the offices of general practitioners and blocking any regionalist drift in health care. These are the three main aspects around which the program created by the Brothers of Italy revolves in view of the political elections of 25 September and illustrated in this interview by the head of health Marcello Gemmato.

Mr Gemmato, how would you summarize in a few lines the main FdI proposals for health contained in your program?First of all, we start from a context analysis in order not to make the mistake of continuing to live by ‘we present’, chasing contingency. In fact, if you notice, after having talked about health related to the pandemic for months, the health issue has long since disappeared from the public debate. We will therefore have to take a picture of the current situation to understand what has led Italy to be the first nation in the world for mortality and the third for lethality related to Covid.

Have you already had an idea on the merits?
I believe the cause was the absence of a strong well-branched territorial health system throughout the national territory. And this element is due to three factors: 1) in the 10 years prior to covid, 37 billion euros were stolen from public health as certified by the Gimbe Foundation; 2) Ministerial Decree 70 of 2015 led to a rationalization of hospitals with the closure of first aid, first aid points and entire hospitals not compensated, however, by an adequate strengthening of local healthcare; 3) the reform of Title V of the Constitution which has led to a health regionalism with an increasingly marked inequality between the health of the North and that of the South. This has also been seen well during the Covid emergency with governors who wanted to buy vaccines on their own or decide whether to close rather than open their territories. I add that I have listed three measures that come from center-left governments led by PD. And I say this to put an end to the cliché of a center-right that wants to undermine public health.

Forgive me but, in addition to a part of the PD, to push on differentiated regionalism are your government allies in Lombardy and Veneto.
True, there are some differences within the coalition. On this we have a vision of a more present state and we believe that before speaking of differentiated regionalism we must address the issue of presidentialism. We believe that in healthcare there is a need for greater national direction, while in other areas regionalism can also represent an added value.

As you know, a provision already ready on differentiated regionalism was about to be presented to the Council of Ministers, do you think it will be taken up by the next government?
I do not think that Meloni accepts ready meals, even on differentiated regionalism any provision must first be ‘contaminated’ by our vision on the subject.

Before you mentioned territorial health, what do you propose on this?
We must not do what is foreseen by the NRP, with the money spent almost exclusively on facilities or equipment. Instead, we want to invest in healthcare professionals, this is the real urgency.

In a moment of crisis like the present one, where do you think you will find the necessary resources for these investments?
Recall that an increase in the National Health Fund has already been approved for the next few years, these resources could therefore be directed to these urgent ones. Furthermore, it is possible to act on waste of resources and managerial inability. Think of the hospital in the Fair, initially it was estimated a cost of 8 million, from here it has passed to a cost of 25 million and now it is closed. Many works drain public money and prevent investing resources on other real needs.

Let’s go back to the health of the territory.
We cannot start from community houses. Recall that one is expected for every 40 thousand inhabitants. This would result in maintaining a patchy health care with small communities once again being cut off from this process. Instead, our intent is to invest in the existing and functioning network of general practitioners’ offices and pharmacies. Two realities that, being already present in a widespread manner, must become the first interface for healthcare in the area.

Can we then talk about a further implementation of the service pharmacy?
The Service Pharmacy Act was implemented during the pandemic phase. The presence of this extraordinary network has served the State to mark the presence of the NHS in the area. Their contribution in terms of vaccination and especially tracing was fundamental. Hospitals without pharmacies would not be able to manage the number of people asking for swabs for diagnosis or to certify that they had recovered. Therefore, confirmation is also good for the possibility of having vaccines against Covid and flu administered in pharmacies even in the ordinary post-emergency period.

The administration of the fourth doses is proceeding slowly, what do you propose to give a new impetus to the vaccination campaign?
The people most at risk by age and pathologies should be sensitized, that is, those who are most at risk of contracting a serious disease or even worse death in the event of contagion. For all these people, strong convincing action would be required. But in our opinion the vaccine should not be mandatory because this measure can produce negative effects. Rather an important role can be played by family doctors and pharmacists, the professionals closest to people and with whom a relationship of trust is often established.

There was no lack of the usual controversies on the limited number to medicine, are you thinking of reforming this access criterion?
Let’s start by saying that over the years the programming has been wrong given that today we do not have many health professionals who are used to treat Italians. As a solution, in addition to increasing the places available for health faculties, we believe that the block at the entrance should not be done in the first year by means of tests that do not concern the candidate’s medical-scientific preparation. In our program we launch the French model with free access to the first year and a selection moved to the second year based on the number of exams passed. In this way, you will be able to move forward those people who have proven their worth on the field.

But how can the quality of training be guaranteed with such high numbers of enrollments in the first year?
The lessons of the first year are not in the laboratory or in the ward, so they could be followed partly in presence and partly at a distance, as we have unfortunately already learned to do during the period of the Covid emergency. We are talking about an organizational effort with respect to which we should equip ourselves.

Speaking of training, what is your point of view on the ECM?
We have no particular idea regarding this issue. The ECM is sacrosanct to the extent that even new pathologies require a timely and constant update. Medicine is constantly evolving, Covid has given us a hard lesson on this, and therefore being constantly updated is essential.

Do you think regulatory intervention is possible to resolve the issue of reimbursements for former postgraduates?
If there have been unrecognized rights, an ethical state has a duty to recognize them. Unfortunately, there are complications given that at the moment the state budget is what it is. I do not want to commit to promises that I am not sure can be kept once in government but I certainly confirm our political commitment to resolve this situation which has arisen.

Giovanni Rodriquez

See our other interviews ahead of the September 25 elections: Zampa (PD), Ricciardi (Action), Castellone (M5S)

September 22, 2022
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Towards the elections. The health officials of the parties speak. Gemmato (FdI): “More resources for staff and to target family doctors and pharmacies on the territory”. Then the stop to the allies: “No to differentiated regionalism in health care”