1705119555
by Gian Massimo Gioria and Antonio Barilla
10th generation – Dear director,
Every year, right in November/March, the problem of overcrowding arises at the DEA: citizens spending days on stretchers without distancing from each other, departments reducing their normal activities to make room for first aid requests, etc. Every time it seems to be something new, but in reality it is not.
Obviously, at this time everyone is looking for the culprits, especially some forgetful “tribunes” and incompetent politicians; Some actually ignore the causes of these serious inconveniences, while others, however, try to hide their serious flaws from people. Everyone is therefore looking at the moment, but not at the causes of this announced health catastrophe.
The regions and local health authorities are well aware of the age-old problem, but instead of acting in a timely manner and developing a serious plan to deal with the flu and paraflu emergency (this should be done in September/October), they ignore it Or rather: They act as if they care and look for last-minute remedies that are as hasty as they are ineffective. Unfortunately, if political behavior stays as it is, it will get worse from year to year.
Of course, at this time of year, hospitals and especially the DEA are in the eye of the storm, but we must not forget that over 90% of the population’s health problems are treated locally, primarily by primary care physicians.
However, let’s try to understand the origin of this recurring phenomenon.
In addition to the delayed and ineffective actions of local health authorities and regions, underlying causes must be identified, which can be summarized as: “The population is aging and hospital care is decreasing in terms of beds and more.” . To this end, we report some very important data extrapolated from authoritative magazines in the industry. In 1980, the proportion of people over 65 was 13.1% of the population and those over 80 were only 2.1%; These percentages have increased, reaching 16% and 21% of those over 65 in 2002 and 2020, respectively. Today this proportion is 24%, of which 7.6% are over 80 years old; In Italy there are around 14 million people over 65. Another set of data that can be useful to understand some phenomena such as long waiting lists, overcrowding in hospitals and not only in the DEA, the long wait for operations and healthcare services in general . is the trend in beds.
In 1980, there were 922 hospital beds per 100,000 residents for acute care patients; today there are 275. Between 2000 and today alone, over 80,000 beds have been eliminated.
Someone will say: “But has the same phenomenon occurred in Europe?”
Let’s take Germany as an example:
– Beds in 2000: 911 x 100,000 inhabitants (82 million inhabitants); in 2020 781 x 100,000 inhabitants (83 million inhabitants).
On the contrary, in Italy:
– Beds in 2000: 470 x 100,000 inhabitants (population 57 million). In 2020 318 x 100,000 inhabitants (population 59 million).
The situation becomes even more serious when one considers that the proportion of people over 65 in Italy is the highest in Europe.
When analyzing these data, a purely Italian paradox emerges: the population has become older and the number of beds has increasingly decreased, even compared to other European countries. Some would say: “Health in reverse gear!”
It was probably the “foresight” of the Italian political class over the last 30 years to imagine that as you get older you feel better and therefore need less and more hospital care.
Certainly the dramatic situation that is evident today is the result of decisions such as: reduction of beds, cuts in medical and nursing staff, cuts in services, unbridled use of services by private individuals, cooperatives, etc.
This is what happens in Italy. In Piedmont the situation is not very different, both in terms of hospitals and local health care, where, for example, there is a lack of around 600 general practitioners and the same number of doctors for continuity of care, according to the parameters of the national contracts. There is a shortage of home care workers and there is talk of entrusting home care to cooperatives.
Furthermore, there is no hospital-territory integration other than in the statements.
The concept of “bulk distribution” has also characterized the change/disruption in the delivery of health services over the last 20 years, through the emergence of “health discounters” where the workforce is precarious and underpaid and the services are not provided using the materials provided are often not of excellent quality.
We are a region where citizens travel far and wide throughout Piedmont to receive a health service, choosing to pay because the cost of transportation is higher than the cost of the service itself.
None of our bureaucrats or politicians have ever faced the problem of thinking: “But how can an elderly person (in Piedmont there are over a million over 65s) move from Moncalieri to Domodossola, from Chivasso to Cuneo or from Turin to Novara ?” for a performance? Can he walk independently? Alternatively: Who accompanies him? How much does it cost him?”
In a few months we will no longer be talking about emergency rooms and will be talking about waiting lists again; “The singer will change, but the music will be the same.” We will see citizens making a pilgrimage for a health service or, even worse, paying for a service to which they are entitled, for free. General practitioners inundated by bureaucracy who, in addition to dealing with daily complaints, also suffer from the sometimes violent outbursts of citizens.
What is also worrying in the Italian healthcare system is the inertia of citizens, who are likely to feel tired and helpless and passively accept and pay for services that they should receive for free. A serious protest, together with doctors and nurses who often work in inhumane conditions, are understaffed and forego vacation and rest, would perhaps help shake the conscience of those who have the power to change this situation.
Gian Massimo Gioria
Smi National Manager – Affiliated area
Antonio Barilla
Smi Regional Secretary – Piedmont
January 10, 2024
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