ROME (ITALPRESS) – Resources for the coming years and the political debate on increasing resources to fund health care are likely to fall short if the system is not put in a position to be truly sustainable.”The NHS needs to declare its vision and link it to resources,” said Tonino Aceti, president of Salutequità, which today in Rome at its annual Summit “Equity and Health in Italy,” presented seven indispensable levers to make the Health Service truly effective and efficient with a focus on sustainability in a perspective that goes beyond the merely economic one and includes combating inequalities and protecting the right to health.The discussion promoted was attended by the highest officials of national and regional healthcare and the main scientific, civic stakeholders and experts who discussed the model needed to ensure a sustainable, equitable and responsive NHS to the evolving needs of society so that the defense of equitable and universal healthcare is one of the priorities in the discussion of the Budget Law.Tonino Aceti, President of Salutequità, said, “The first test case for the sustainability of the NHS is the Budget Law currently under discussion, and the findings on the resources allocated to health care by the Court of Auditors, the Parliamentary Budget Office and CNEL are worrying and must be addressed immediately. The NHS must declare its vision and link it to resources. That is why we have doubts about the effectiveness of the measures that allocate about 1 billion euros to increase resources for the achievement of National Health Plan (NHP) goals, both because the last approved NHP dates back to 2006 and because after the minister’s announcement last year that he would finally update it, to date nothing is known about it. And if the Plan is not updated, the NHS will continue to be funded without having health planning and a clear vision on priorities, goals and actions to be put in place. And another big absentee is the Health Pact that is stopped at 2021. Even on the waiting list emergency, 50 million euros for 2025 and 100 million for 2026 risk not affecting accessibility to care as much as they could if regions continue to be measured on old indicators on which almost all are already compliant. Similarly, the new funding tied to updating LEAs may not be used as it has already happened for the entry into force of the new LEAs with as much as a 7-year delay. At risk is access to therapeutic innovation for patients due to measures that preclude new innovativeness evaluations on new therapeutic indications for drugs that already obtained it 6 years earlier. Just as any surplus from the Innovative Medicines Fund must remain in pharmaceuticals and not in the indistinct cauldron of the Regional Health Fund. On humanization, the signal is also insufficient: too few 10 million for palliative care, considering that 8 regions as of 2021 had not established a pediatric palliative care network. The strengthening of the New LEA Guarantee System, which picks up a specific Salutequità proposal, is good. Precisely because it is too important a game for the sustainability and equity of the NHS, we wanted to deliver our proposals, with analysis data and actions summarized in the 7 levers for sustainability. “The proposals discussed are divided into seven levers, each of which identifies concrete actions to address what have been identified as the main challenges of the National Health Service.First lever: Definition, allocation and management of resources. A methodology for calculating standard health care needs is needed, moving beyond the “historical” and only “political negotiation” to more objective and up-to-date criteria, such as the Essential Levels of Care (LEAs), the rate of renunciation of care and poverty, population characteristics, epidemiology, technological innovation, adequate personnel and infrastructure, organizational/structural/technological standards, health mobility, and orographic characteristics of the territory. The financing of the SSN must be pegged to a multi-year strategy for health and the strengthening of the SSN, through the definition and approval of a new National Health Plan, adopted with a procedure that is more ‘fortè than that provided for in 2006.The criteria for the distribution of the Health Fund must be changed, giving more weight to social deprivation and those of the premium share (644 million in 2023) by moving from negotiation between regions to transparent, objective and binding criteria. And again, moving from a payment-by-performance system to one that finances treatment pathways and their health outcomes by overcoming budget silos and putting the value of care at the center. Then, simplify access to health building funds and incentivize research and innovation to make the SSN more effective and sustainable in the long term.Second lever: Monitoring, measuring and evaluating performance. It is a priority to act on strengthening and innovating monitoring and evaluation of the Essential Levels of Care (LEAs) delivered by the regions through new indicators-including in the intra-regional dimension-and more dynamic governance. There are plans to modernize the LEA fulfillment system, improving timeliness in data publication and introducing new evaluation criteria for critical elements such as waiting lists, the Electronic Health Record and the implementation of State-Region Agreements subsequent to those of 2001. A central role should be assigned to the Agenas platform to monitor compliance with maximum waiting times and closed agendas, while the National Outcomes Program should be strengthened to better assess the outcomes of territorial care. Finally, proposals include introducing tools to measure the impact of pharmacological, technological, organizational and professional innovations and reallocate related economies also by promoting effective public-private collaboration.Third lever: Innovation in organization and governance. To make healthcare companies more efficient and flexible, a reengineering of the operating model is proposed, addressing regulatory and contractual rigidities (labor, partnership, etc.). And still among the proposed actions is the creation of a multi-year program to improve the enhancement and attractiveness of NHS staff with interventions on pay, training and recruitment. In addition, the decrees to define the methodology for calculating staffing needs must be approved promptly and DM 77/2022 and the PNRR’s digital health measures must be implemented quickly. It is also necessary to fund the updating of the National Plan of Chronicity by including new pathologies (e.g., psoriasis, chronic hematological neoplasms, etc.) and ensure their more effective monitoring, as well as ensure quality, personalization and therapeutic continuity in purchasing procedures.Fourth lever: Dynamic updating of LEAs – Essential Levels of Care. It is proposed to update the Essential Levels of Care (LEAs) annually using funds allocated by budget laws, making the process faster, more participatory and transparent. In addition, it is necessary to define and monitor new care, structural and technological standards in areas that are not yet regulated.Fifth lever: Waiting list government. Reducing and governing waiting lists must become priority goals of a new National Health Plan, with annually restricted funds for the regions. It is proposed to strengthen the monitoring of LEAs with new indicators, issue the implementing decrees of the law on waiting lists. In addition, there is an urgent need to work on the appropriateness of prescriptions and clinical practices through the National Guideline System (SNLG) and the ISS’s Good Clinical and Organizational Care Practices to support professionals and administrators in making choices and ensure sustainability and quality.Sixth lever: Quality of decision-making processes for equity and the sustainability of the NHS. Improve the quality of decision-making processes in healthcare by giving centrality to evidence and the participation of patient associations and stakeholders, as well as through the reinterpretation of the principle of loyal collaboration between State and Regions, to ensure better sharing of choices, greater speed of decisions and their implementation.Seventh lever: Awareness of the value of the SSN. Develop initiatives, programs and campaigns, starting in schools, to raise awareness of the positive value of the National Health Service (NHS) and the active role they can take in protecting their own health and contributing to sustainability.-photo press office Salutequità- (ITALPRESS).
