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Healthcare cuts, experts divided on risks and opportunities

The spending review? It is nothing more than a maneuver made of linear cuts. No, on the other hand, it's an opportunity not to be missed to finally close small hospitals. The operation to redevelop public spending set up by the Monti government divides the experts. Two in particular: Angelo Lino Del Favero, general manager of the Molinette of Turin and president of Federsanità Anci, and Nerina Dirindin, professor of public economics and finance science at the University of Turin and former health councilor of Sardinia. In recent days, they have both written about the spending review (the first in the Federsanità bulletin, the second in the economics web periodical Lavoce.info), expressing considerations that are not only divergent, but also deserve to be juxtaposed because they fuel opinions.

Let's start with Dirindin: according to the teacher, "a new summer maneuver made up of linear cuts is hidden behind the slogan of the spending review", which however risks nullifying the results achieved so far. "Healthcare" he writes "has already done a lot in the direction of the spending review" thanks to budgetary disciplines that require regional governments to pay off deficits and commissioners. This is confirmed by the fact that in the last six years (from 2005 to 2011) the growth of current health expenditure has remained below the primary one of the Public Administration (+15 per cent against +18 per cent in the period 2005-2011). In this context, the spending review «imposes the same interventions indiscriminately on all Regions, pen! alysing the more advanced ones and creating an alibi for the technically and politically less mature ones». What's more, "it does not intervene on the quality of spending, risking simply shifting costs from the public budget to the pockets of citizens, especially the most fragile".

Del Favero, on the other hand, focuses his attention on the intervention concerning the beds. There is no longer the roof that decreed the closure of the smaller structures, but that is the direction in which we must go. "Health organization experts have been supporting the need to close small hospitals for at least twenty years," writes the president of Federsanità Anci. "Arised here and there in the country above all for electoral reasons", they are "dangerous and expensive" and "must be converted into polyclinics and low-intensity hospitalization structures, thus responding to the need to strengthen the territorial health offer, but postponing the urge! nze to "real" hospitals». For Del Favero, «the challenge of the future is in the network: highly specialized centres, hospitalization structures with high technological standards and then the network of hospitals, clinics, first aid points». The spending review, consequently, «is something more than a spending control tool, because it requires us to reconsider the very way in which we spend. It's not just a question of "cutting", but of carrying out a profound revision of the business processes to arrive at better costs and better services». The debate is open, as they say.

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