Author: Action Institute
Date: 1 July 2014
The public consultation was started by Action Institute on the 13th of January 2014 and lasted 35 days. 118 speakers, 38 of which representing Public Institutions at the national and regional levels, were invited to offer their contribution.
This process ended the 11th of March 2014 with the organization of the event “Healthcare Roadmap 2030 – a coherent set of reforms aimed at preserving the universality and fairness of the National Health Service” at the Antitrust Authority in Rome. The event hosted more than 150 participants who attended the Roadmap presentation and contributed to the discussion about the reform of the Health System. The observations came out from the event are essential part of this document.
The discussion generated 22 contributions, among which: (i) 8 represents Public Health Institutions or Authorities; (ii) 5 were offered by academics or Universities; (iii) the rest belongs to civic associations, health operators and enterprises. The list of the participants, made by individuals, Institutions and Associations, includes among others AGENAS, AGCM, On. Yoram Gutgeld (PD representative), On. Nerina Dirindin (PD senator and member of the parliamentary committee about Health and Hygiene), Professor Renato Lauro and Professor Francesco Dotta (IBDO Foundation), Professor Mario La Torre (University Roma La Sapienza), Professor Paolo Villari (University Roma La Sapienza), Conferenza dei Comitati Consultivi delle Aziende Sanitarie of Sicilian Region, Società Italiana Medici Manager, Doctor Tommaso Longhi, exponents of Corte dei Conti and Action Institute’s members. The feedback to the consultation was therefore positive, given the objective of stimulating the debate between a greatly diversified set of stakeholders in the system.
In general, the pool of commentators gave a very positive opinion about the note’s content, and integrated or deepend some topics linked to the document.
As for Vision and Core Values, the attention of the commentators was focused mainly on the idea of prevention, as an objective and treatment strategy, suggesting to mention it in the general vision of the Roadmap. It was also remembered the issue of the interaction between public and private in the field of healthcare providers, both regarding the potential for services’ enhancing, both as an element to analyze deeply while taking into accounts the redistributive effects on the users.
Regarding the First Pillar, attention was given to the issue of the provision of goods and services, in particular in the pharmaceutical market, in relation to the problems of competitiveness and transparency. A lot of contributions were dedicated to express the centrality of NHS’ governance as an issue and the necessity to rethink mechanisms that sometimes didn’t prove to be efficient. A comment highlighted the lack of a company structure culture as a cause of the problem of the selection of the ruling class.
During the discussions about the topics linked to the Second Pillar some of the participants expressed some concerns and, although their agreement to the aims of the pillar’s proposals, asked for a greater attention to the complexity of the issue. There were some doubts about the fact that a rise in the information available, also in the form of clinical data, would be sufficient to enlarge the patient’s freedom of choice in a context where sharp informational asymmetries, agency problems and interests conflicts are tied together. The danger of the distortion derived by an imperfect interpretation of the information has to be acknowledged. Moreover, it was recalled the heterogeneity of the performances supplied by the NHS and, in many cases, the relevance of time-dependent nets which presume a compelling entrustment of the patient to a network of providers rather than the free choice in a view of competition between providers. It was also expressed the concern about the implementation difficulties that might rise because of a poor transparency culture and of a weak political support to initiatives of opening and publicity of data. It was remarked how in many cases clear law’s guidelines already exist and that sometimes useful ‘infrastructures’ and competences are available, but that they didn’t create a significant change. However, also examples of good practices regarding patient’s empowerment and his participation to the path of recovery, already implemented in some regions, were offered.
As for the Third Pillar, it was remarked the need to update some of the current methods of comparison between performances (for example the Programma Nazionale Esiti), in particular through the promotion of a truly independent organism of evaluation.
Comments to the Fourth Pillar recalled the importance of a revision of the financing mechanisms toward a greater transparency, standardization and the removal of the criteria’s definition from the political decision maker’s tasks. Some speakers imagined a different role for insurances to help the NHS along lines of innovation and risk management.
Finally, the general comments gathered during the debate touched some recurring themes: the need to include the human capital and instruction topics inside the Roadmap; the importance of socio-health services and of the house assistance for the health system and the hoped integration with the health component; the necessity to think as soon as possible to implementable proposals, in order to face the stickiness that in other occasions prevented the fulfillment of law’s indications.
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