First floor

Doctors, salary cuts for those who prescribe outside the guidelines

"A disguised super ticket that ignores the income capacity of individual citizens and feeds the big business of private healthcare". As Constantine Troise secretary of hospital doctors of Anaao Assomed describes the obligation for doctors to prescribe specialist outpatient services only within the framework of guidelines implemented by the government and promoted by national decree to be applied in the regions. Obligation is one of the legacies ofstate-regions agreement aimed at recovering 2.35 billion euros in two years, now re-launched in a series of amendments to the decree law number 78 for the reform of local authorities now being examined by the Senate. The savings will be guaranteed by a series of manoeuvres. In the order:

• the renegotiation of contracts with NHS suppliers to a reduction of 5% and with suppliers of medical devices to a reduction of 4.4% with the interruption of contracts between regions and suppliers if an agreement is not reached;

• the obligation for producers of NHS goods and services to cover the NHS overrun for 40% this year, 45 next year, 50 in 2017;

• the onset of groupings of therapeutically similar drugs: in all categories in which there is an equivalent which, given the same defined daily dose, allows the same intensity of treatment, the health service passes on the medicine at a lower price and renegotiates with the other manufacturers i supply prices.

But among the various innovations, the cuts to the ancillary treatment of hospital doctors and the variable quota of family doctors who induce diagnostic tests and specialist visits outside the conditions set by an imminent decree from the Ministry of Health stand out. Local health authorities and hospitals will have to raise awareness among doctors because, if they fail to justify a prescription for an exam (which will remain the full responsibility of the patient outside the state limits) they will face a salary reduction.

«It is not clear who and how will draw up the nomenclature of inappropriate services - Troise affirms - but citizens know that through the intimidation of doctors the aim is to cut the services provided, worth about 100 million. In the face of those who ensure that the health system and citizens' right to health are unable to bear further reductions. Here we go again. The government and the regions are thinking of state guidelines or protocols that pervasively limit the responsible autonomy of doctors in diagnosis and prescription by unloading the cost of services on the pockets of citizens".

This time, however, the disguised superticket will not only affect Italians. To be assisted in emergencies, Jubilee pilgrims coming from other countries will have to pay 50 euros each before entering Italy and will have to certify the payment of the sum at the time of using the assistance. Citizens of countries with which Italy has mutual health care treaties are "safe" and therefore EU residents should be exempt.

Mauro Miserendino – Thursday, 23 July 2015 – Doctor33

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