19 JUL – “We are not against the prudent use of resources, but in some Regions the paroxysmal search for savings leads to solutions that upset the system. The meaning of things is being lost." There is concern in the words with which Angelo Testa [in the photo on the right], president of Snami (National Autonomous Italian Doctors Union) rejects the provisions that Tuscany and Lombardy are implementing in these days. Measures which, according to the union, "threaten a heavy impact on family doctors in the two Regions and in return promise economies to be demonstrated".
As far as Tuscany is concerned, Snami is targeting the resolution requiring local health authorities to increase the direct distribution of equivalent medicines by 15%, to be purchased through centralized tenders for a large area with an average discount of no less than 75% of the retail price. The provision dates back to mid-May but according to the information received by Snami, the first tenders should be launched within a few days. “The mechanism – observes Testa – is well known: the producer who makes the lowest offer ensures the supply. Therefore, for each active ingredient, the Region will "pass" only two or three products and the family doctor will be precluded from making any choice on the brand to be prescribed: whatever we indicate in the prescription, the patient will still be dispensed with the equivalent that won the wide area supply ". A scenario that Snami really doesn't like: "We reiterate once again our full trust in generics, but in Tuscany a perverse mechanism is about to be set in motion: the doctor will no longer be able to choose the brand of drug to administer, but will continue to respond to any side effects triggered by the product that the patient has taken".
The second Region on which Snami focuses its gaze is Lombardy, where the experimentation of the project is at the starting line Creg project (Cronic related groups). Basically, it is a territorial assistance organization model that replicates the hospital drg system: for some chronic pathologies, the Lombard Health Service will reimburse based on tariffs based on "care packages"; the direction of these packages is entrusted to a "provider", who in addition to managing the patient according to the "care-manager" methods, will have to contract the services with all the providers, from diagnostic facilities to pharmacies. The Region would like family doctors to assume the role of provider, but Snami fears dangerous drifts. “The doctor must look after the patient's interests – is Testa's opinion – thinking that he can start negotiating with suppliers to negotiate costs and tariffs means pushing general practice towards roles that do not belong to him and are not in his DNA. I repeat, we are losing the sense of things; it is one thing to review the organization of health services, another to invent revolutions that turn the system upside down without giving any certainty”.
July 19, 2011
