A new paradigm to humanise the care pathway

Is it possible to make an assessment outside the polemics between the majority and the opposition of the budget law's measures on healthcare? At the very least, it must be done out of respect for an ageing population that is increasingly in need of appropriate care, and out of respect for the medical and nursing staff who hold up the fortunes of the public health service amidst growing difficulties and the impatience (justified and otherwise) of patients and their families. We also believe, but this is outside our sphere, that the political forces should lay down their arms on health care and instead seek bipartisan solutions, since we can and must clash on everything but health care management, since it absorbs enormous resources (6.3 per cent of the gross domestic product is perhaps not enough, but at the same time it can and must be better spent by the regions) and conditions economic life itself, since those who are not well also perform less in work and in society.

Let us say right away that there are two very important novelties that Minister Orazio Schillaci and his collaborators, with the agreement of Palazzo Chigi and the Mef, have managed to introduce into the country's most important law: the first is the increase of 2.4 billion euros for 2025 and 3.2 billion for 2026 of the National Health Fund (and this is no small thing given the constraints of public finance); the second is a regulation that opens up the work for the unitary path of care necessary to balance the hyper-specialisation of current medicine, to put the patient back at the centre of care and not the individual service, and by this route also arrive at containing expenditure. Today, in fact, the instrument that delivers health services is the same one that has operated since the birth of the National Health Service and is centred on the individual services needed to treat each health problem. Hospitals, professional responsibilities and even the economic control of expenditure are organised around this management architecture, without forgetting the cultural and teaching dimension of a medicine that has become hyper-specialist. The continuous growth of health needs in a progressively ageing population and the exponential increase in the costs of scientific research and biomedical technologies have broken that fragile balance between maintaining quality and access to care and the sustainability of costs, and it is therefore essential to change pace.

The additional 2025/2026 budget is needed to accelerate the digital transition of healthcare by enhancing the Electronic Health File and the development of integrated platforms to improve access to and management of clinical data; to increase the number of doctors (thirty thousand are missing) and reduce waiting lists for specialist visits and diagnostic examinations; to strengthen territorial medicine, with funding to develop Community Homes and Hospitals, as well as prevention programmes for chronic diseases. These are the interventions that Orazio Schillaci rightly considers indispensable in the short term, even though he is well aware that the risk of inefficiency and waste is a constant concern, that there is a need for greater transparency in the allocation of funds, and that territorial disparities between the North and the South remain in terms of both infrastructure and access to services.

Article 64-bis, again according to the minister's intentions, represents instead the first strategic step towards the new paradigm of care through the experimentation of innovative models for the management of health services. The article in fact introduces the launch of experimental organisational protocols that will see the sick person at the centre of the care pathways, also with a view to promoting the so-called humanisation of medicine, a crucial but often neglected aspect in the debate on public health. The experimental programme could envisage a matrix-like management architecture in the places of care; customised care paths (each patient will be followed through protocols that take into account his or her physical, psychological, social and cultural needs); psychological support and more welcoming environments to reduce the stress linked to hospitalisation and care; training of operators also for empathic and respectful care; involvement of families in the care pathway, thus improving patient support.

We know that the concept of the humanisation of care could lend itself to misunderstandings since, of course, even today's healthcare professionals consider the patient not just as a clinical case, but as a person with complex needs, but on this very delicate terrain we need to do more by also fully invoking the central role of bio-ethics in the care of the sick person.