Healthcare, tightening up on prescriptions to reduce waiting lists and the cost of services

There are too many prescriptions for unnecessary examinations and tests that are flooding the National Health Service and lengthening the queue of Italians waiting for treatment. In order to try to climb the mountain of waiting lists, which, as Istat has just certified, are the main reason why 3 million Italians give up treatment, the government has decided that it will not only aim to increase the supply of services, but will also intervene on the demand for health. How? In the decree on waiting lists "expected in the council of ministers within 15 days," as Health Minister Orazio Schillaci recalled yesterday, one of the most important chapters will concern what insiders call "prescriptive appropriateness": that is, curbing the too many prescriptions of family doctors, but also of specialists for services that are often unnecessary and that represent a "waste" according to experts that amounts to up to 10 billion a year. Defensive medicine - i.e. the fear of lawsuits and complaints from patients, on which the government has intervened by also introducing a penal shield for the whole of 2024 - in fact pushes many white-collar doctors to prescribe an ultrasound scan or an extra examination, thus forcing those who really need it to wait longer. According to Minister Schillaci, this inappropriate demand accounts for at least 20 per cent of all prescriptions.

Among the other chapters of the decree - this time on the supply side - the possibility is also being studied of allowing hospitals to 'purchase' from their own doctors services in free practice (the intramoenia that many white coats already do as private activities in the NHS facilities) precisely to cut waiting lists. Another important step that will require the approval of the Ministry of the Economy is also the gradual overcoming of the expenditure ceiling on personnel, which limits the Regions' recruitment in the health sector to the amount spent in 2004 minus 1.4 per cent; a first step in this direction could appear in the decree.

But let us return to the mechanism that is being put in place for appropriate prescribing: first of all, it will be compulsory for the doctor to indicate in the prescription the diagnostic question linked to the service (according to the international standard Icd-9-cm) so as to track all the services well by diagnostic areas thanks to the wide availability of the data already collected today, but which are often incomplete. On the basis of the patient pool of each prescribing doctor, the number of prescriptions potentially expected will be calculated and if this 'ceiling' of prescriptions is exceeded, a 'red light' will come on. This will allow each region to intervene in a given area by reaching individual white coats to understand the reasons for too many prescriptions and thus bringing groups of doctors or doctors who prescribe abnormally back on line.

At the moment, there are no plans for ad hoc 'sanctions', even though in the past there have already been convictions for financial damage by the Court of Auditors for over-prescribing doctors. On this front, the guidelines that the Istituto Superiore di Sanità (Higher Institute of Health) is working on, to which the decree will entrust precisely the task of indicating to doctors good practices certified by scientific societies for therapeutic areas that will give more certainty to doctors on the right prescriptions for examinations and therapies to follow, will also help.

The decree - on which the verifications with the Mef are being completed in these very days for the coverage - as said, will also intervene on the supply side: in order to reduce the waiting lists, the ASLs will have fresh resources to pay the overtime of doctors and nurses with Agenas, the Agency for Regional Health Services, which will monitor the waiting times for each hospital. 'We want Italy, region by region, to finally control where and what services are missing,' Schillaci reiterated yesterday. With the possibility, and this is the hypothesis that is taking shape, of also being able to buy free professional activity (intramoenia) from doctors who, once their eight hours are up, will be able to be hired directly by the hospital instead of by the citizen, as happens today.