In Modena, a 1,800 euro prize for the family doctor who prescribes fewer examinations and visits

In Modena, general practitioners who prescribe fewer specialist examinations or laboratory tests will receive an economic incentive of 1.2 euro per patient per year from Ausl. On average, since each practice has 1,500 members, the bonus will amount to 1,800 euro. This is provided for in an agreement signed by the health authority with the general practitioners, represented by the Fimmg, 'to promote the appropriateness of prescriptions'. Doctors will have to keep the number of prescriptions for specialist visits and examinations within a margin of about 25 per cent of those made in 2024. The services involved concern twelve types of examinations and specialist visits, including: vascular surgery, dermatology, physiatrics, gastroenterology, ophthalmology, otorhinolaryngology, pneumology, urology, as well as CT scans, MRI scans, gastroscopy and colonoscopy.

The horizon of the agreement, explains the Ausl, is the concept that prescribing the right examinations and tests, for the right patients, i.e. those who need them, means using healthcare resources responsibly and efficiently. "The objective," explains the Ausl director general, "is not to induce doctors to indiscriminately prescribe 'less'. Rather, it is to provide tools and data to assess, as individuals and as a professional community, how and where we can prescribe 'better', providing incentives to be virtuous. Even when this means having to explain to a citizen that the examination they are asking for is not really necessary, which is a very difficult part of the doctor-patient relationship'.

In short, for the director of the Ausl, the measure is 'innovative', and while some general practitioners have adhered to it, others have expressed strong misgivings, emphasising that the incentive targets are not directly governable by general practitioners, since many prescriptions are derived from specialist indications or patient requests.

On the issue there is a question from Fratelli d'Italia, with the first signature Annalisa Arletti, asking the Region to make 'a careful reflection', clarifying 'whether it intends to extend this model to other health authorities in the area'.

"The potential effects of the measure on the quality of care, on clinical appropriateness, and on citizens' access time to specialist services are fundamental aspects to be taken into consideration," pointed out FdI, which asked whether "impact studies or comparative analyses have been conducted or are underway to verify the actual correlation between economic incentives and improvement in prescriptive appropriateness. "The measure," added Arletti, "risks undermining the citizen's trust in the doctor who, in the eyes of the patient, could take decisions to go in the direction of receiving the economic incentive".