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The Covid-19 emergency highlights the criticalities of the Lombard model. The acclaimed medical care of excellence in Lombardy, where the public and the private have been placed on the same level over the years, is fragile in the face of the virus. Organizational difficulties and gaps in local services. How does it come out? There are now five proposals for change in the field, with the same number of documents written in recent months. the Messenger Service read them all. One from the Ministry of Health, requested by Minister Roberto Speranza through the National Agency for Regional Health Services (Agenas). Three reform projects are prepared by study groups created within the Region himself (headed respectively by the former director general of Social Welfare Luigi Cajazzo, 5 wise men appointed by the governor Attilio Fontana and the Lega with Emanuele Monti). Another from the Democratic Party. Must be corrected the reform desired by Roberto Maroni in August 2015, law 23, today at the end of its 5 years of experimentation. Roberto Formigoni’s goal of restructuring the hospital system of twenty years failed: the construction of the new house was left halfway and without basic rooms to live well.
Chain of command
The first problem concerns the chain of command, which is constantly blocked because it is too fragmented. Lack of coordination. One example among many comes to understand how it affects citizensof the organization of calls for Covid hotels. On August 5, with resolution 35.25, the Region instructed the 8 Health Protection Agencies (Ats) to take actions to find places. Everyone has their own path (reimbursement per day for installation and requirements) and everyone is late. For the Agenas, now led by Domenico Mantoan (historical director general of the Veneto Health Service), a strengthening of the governance regional. The idea put on the table is the establishment of a regional agency / single Ats / single company with possible territorial sub-articulation. To understand: the 15 famous ancient Asl of the Formigonian era are replaced in August 2015 by 8 health protection agencies. Your homework there health planningIn other words, define who has to do what. But Agenas’s view that the joystick cannot be held by too many commanders. Better just one. Net of nuances, the request similar to that of the 5 essays proposed by Fontana: Unitary of the governance functions of the system headed by a single structure (strengthening of the general direction of the Welfare department or of the single Ats model or agency model / external company, writes the essays led by the former rector of the State of Milan, Dr. Gianluca Vago. The League calls for the creation of a Welfare Company. Samuele Astuti, head of the delegation of the Democratic Party in the Health Commission: An agency regional for the government.
The division of roles
Today, the offer of services, which must combine prevention, family doctors, outpatient clinics and hospitals, is not from the same commander: a little depends on the Ats, a little on the Local health and social agencies (Asst)Once simple hospitals, which with the Maroni reform have also become the container for territorial services. Transfer to the Asst of all the disbursement functions currently performed by Ats – writes Agenas -. That is, prevention and primary care. An important room to build in this context is what, in technical jargon, is called a district: The ASSTs must be divided into districts with variable dimensions – the trials propose -. Here professional and organizational relationships with affiliated specialists are managed. For the Democratic Party an essential piece: Districts must be physical locations, also easily recognizable by citizens, where the offer of health, socio-health and social services is articulated – Astuti emphasizes -. Mayors, both here and in the regional government agency, must have a leadership role. La Lega: The point of contact between the hospital and the territory is the Health District (physical place of integration between dispensers, pharmacies, social and health organizations and users).
The health houses
The councilor for health Giulio Gallera defines them as structures that serve to provide alternative responses to emergencies and hospitals. In fact, in Lombardy, although provided for by law 23, territorial hospitals (Pot) for low intensity care and structures that provide medium / low intensity ambulatory and home health and social health services (defined as Presst, that is, , territorial socio-sanitary facilities) were never born, except in exceptional cases. The Agenas network: Need to redefine the role and numerical implementation of territorial hospitals (Pot) and territorial socio-health centers (Presst), as well as the professional profiles that operate in them. Health houses, as defined by the Democratic Party, are essential: Today the Lombards go to the emergency room – Astuti comments – because in the territory there is no alternative.
The public-private relationship
For Agenas it is necessary to dismantle the assumption that the public and the private are at the same level. Their role must, in any case, be complementary: ASSTs must negotiate with accredited private health services the offer of services based on the needs of a single territory (with the exception of large groups such as San Donato or Humanitas whose contracting may remain in chief of the Department of Health). Asks the League: Identification of three-year / five-year plans with accredited individuals based on specific territorial objectives, prioritizing the reduction of waiting lists. Astuti, Pd: accredited private health care must be governed to have an offer of services according to the needs of the territory. In short, in Lombardy in the coming months there will be a lot of work.
November 28, 2020 (change November 28, 2020 | 07:05)
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