24 AUG – Dear Director
With regard to the event scheduled for 27 October in Rome on the subject of linear cuts in the spending review in healthcare, in my opinion the analysis of motivations and perspectives argued by Ivan Cavicchi with his articles is lucid and incontrovertible (read here And here). My same consideration for your editorial on the attention diverted solely to the review of pharmaceutical spending, in particular to the prescription of the active pharmacological principle instead of the commercial package.
On the whole economic system, and therefore also on the health system, the spending review should have involved, in addition to the cuts, the study of measures from a very different structural and planning perspective: for example, on the reorganization of primary care, on the freelance profession within the NHS, on the reorganization of the staffing staff based on the work performed and not on the basis of the historical reference data, or worse on the basis of logics in which the organization has long been centered on power, including political power.
An objective has never been identified so far: that of an "earnings review" in economic terms of direct and indirect benefit of an appropriate, effective, efficient NHS. And only from the combination of spending review and earning review, as from any other financial statement between expenses and income, can a serious project of "financial statement" and "asset allocation strategy" derive
Instead, these lines of progress have remained dead-ends, with timid and only superficial attempts at reorganization, where deregulation combined with the ax of cuts risks becoming the grave of the NHS.
Primary care is an example of a truncated track in its own redesign, and after all on this topic Cavicchi himself hinted in his item to the inadequacy of any false change.
If you really wanted to apply non-linear cost analysis criteria to primary care, the questions to ask yourself, to give a serious answer even before inventing fake solutions, or pretending you want to invent real solutions, would be: how much does a 15-hour weekly assistance from local medicine cost and how productive is it?
How would that compare to 38-hour-a-week care provided by employed physicians? Which ones are they