When we talk about Healthcare in Italy we tend to shoot at the Red Cross: the first term that comes to mind is medical malpractice with all its derivatives, biblical waiting lists, clamps and gauze in bellies, diagnostic errors, deaths in operating rooms, etc. The so-called medical malpractice will not be the object of this analysis, if not on a collateral basis, as an effect and not a cause of the current deterioration. With this we do not want to deny its existence, if anything, to resize its entity in the context of what remains (for a little while longer) the best part of Italian Healthcare, the clinical one, and which thanks to the hidden and silent hard work of many healthcare professionals , continues to keep us (always for a little longer) at the highest levels of world assistance.
The correct understanding of the phenomenon is possible only starting from theanalyses history of 2 specific events: the student revolution of 1968 and the health care reform of 1978. Far from wanting to go into the merits of these historical episodes, only the effects deriving from them will be analysed.
Student Revolution '68: the practical consequences were:
a) exponential increase in the university student population (more or less in all faculties) within logistical, educational and organizational structures that are absolutely not equipped to welcome and manage it. This resulted in a general reduction in the quality of teaching and an increase in the mass of graduates: in the medical faculties, individual students could have more difficulty accessing hospital wards, libraries, and in general could have less effective contact with the teaching staff, to the detriment of the essential theoretical-practical training in medicine. To this were added certain laxities of ideological derivation (18 political, liberalization of study plans) which eliminated the selection and paved the way for scoundrels and the ignorant. Result: more quantity, less quality.
b) As a consequence of a) there was an exponential increase in the number of doctors in Italy, which led to a tenfold increase in the doctor/inhabitant ratio from the 1960s to 2000 (so much so as to coin the term of medical plethora), with a series of devastating repercussions very well analyzed in a item released in 2003.
c) As a consequence of b) it was necessary to upset and reorganize the Italian health structures to give work to the medical plethora. To give an example, the medical guard was invented: what was previously done entirely by a single figure (the family doctor or the general practitioner), was divided into two figures (the attending physician and the medical guard). This was the case for hospital wards, university professorships, etc.: all Italian healthcare facilities were inflated out of proportion for decades, without this preventing the underemployment/unemployment of about ¼ of the medical population (with borderline cases of medical graduates or waiters, comparable to Cuban taxi doctors).
Healthcare reform '78: as a result of the inexorable post-1968 weakening of the medical class (from selected competent and compact, to plethoric incompetent and partisan) the ideal conditions were created to enact the law 833/78, which instituted the
