That "glass ceiling" that the regions are still unable to break through in healthcare

Overall, the correlation between the performance index and the level of citizen satisfaction is strong for the hospital (0.79) and outpatient (0.80) care areas, low for the social and non-self-sufficiency areas (0.55), intermediate for primary care and access to medicines (0.64). For these last two aspects, satisfaction is generally high throughout the country, without particular critical issues.

The study also analyzed the quality of life related to health, highlighting that Trentino-Alto Adige confirms its position at the top with a value of 0.938, while Umbria records the lowest value, equal to 0.840 QALY (unit of measurement used in the cost-utility analysis that combines the duration of life with the quality of the same). According to the Crea study, the quality of life is not strictly linked to health performance: some regions in the South, despite having low levels of health performance, record a higher quality of life than better performing regions. "This phenomenon - the Crea also notes - is attributable to cultural, educational and environmental factors, as well as to the different expectations of citizens".

The indicators that lower performance are precisely those on which the greatest bet should be played: we continue to have a level of hospital care for acute care that works but in an elderly population we are totally lacking and so are everyone: still very far from the acceptable standard on docimiliarity and non-self-sufficiency. "The community homes still without staff and far from full social-health integration, with Mission 5 and Mission 6 separated even in the National Recovery and Resilience Plan, cannot constitute an answer today and in this condition the referral to hospitals is triggered as a consequence - observes Federico Spandonaro, coordinator of Crea Sanità -. But the same Italian hospitals have 30% fewer admissions than twenty years ago with the lowest hospitalization rate in Europe. The hospital today essentially provides specialist care because this is how our medicine has become, also thanks to the technologies available. In this context, non-self-sufficiency must be taken into account: the NHS must expand its competences by also managing this area that until now has been considered non-healthcare. Then we must start training people: we always talk about doctors and nurses but what is needed for the elderly are Oss who know how to look after them and not carers who are also working “under the table”».

Compared to the results of the main survey on performance, "the more the years pass, the more the panel raises the bar of values ​​that it considers optimal on the indicators and no one gets there - Spandonaro observes again -. It is not possible to go beyond a certain level of expectation because probably today the system can no longer cope with the resources available and with the structure it has to satisfy expectations". But then, if Veneto, which is the first region, barely reaches 55%, it is as if there were a "glass ceiling". What kind of effort would allow the first and all the other Regions to break through it? "We are also working with colleagues from Bocconi on a possible model for reforming the system - explains the expert -. Obviously the easiest answer would be to put in more money but on the one hand there is none, on the other if the structure and organization are not changed, very little can be done with the money. We have been saying for years that a new vision is needed, in the face of 25 billion in private spending. We need to think of an organization that involves citizens more as well as health funds and recovers that private expense that impacts for a quarter. By now the system guarantees the clinical act for acute cases but it is absolutely not possible to guarantee an organization capable of satisfying people's expectations".

Private spending accounts for a quarter, Spandonaro points out, and "this is a fact that we can no longer ignore": as Bocconi data reports, today the system is able to guarantee about 60% of the services it prescribes because, net of the inappropriateness that certainly must be considered, there is an actual share of people who are forced to turn elsewhere. "The same supplementary health funds are a defense of the middle class and certainly not something for the 'rich' - Spandonaro observes - being mostly collective and corporate. We need to find a way to collaborate, also taking into account that many of these funds ask to be able to use the facilities of the NHS by paying for the services. This also means rethinking the system". But with which staff? "If we set up an accreditation for the solvent activities, then we could also afford to hire more staff to then also employ in the official channel - is the answer -. But this would be an epochal change with respect to the system: what is certain is that the NHS cannot be defended by simply saying that everything that "doesn't fit in" is inappropriate, useless and unfair. We cannot continue to entrench ourselves in outdated positions".