Hospitals in Italy, few, often obsolete but still indispensable. Time for a change

by Cesare Fassari

14 JUN – In Italy, you know, we are famous for going from one extreme to another and this is also true for our hospitals.
Until about twenty years ago, our hospital park was among the “richest” in Europe, today the latest statistics place us at the lowest, with a rate of beds per inhabitant among the lowest in the continent.

This dramatic decline was obviously not spontaneous but the result of a precise programmatic decision followed by all governments of all colors that have followed one another over the twenty years and based on the assumption that our health system was too “hospital-centric”.

Beds and structures had to be cut in favor of a simultaneous strengthening of extra-hospital care, the so-called “territory”.

We know that this transfer certainly occurred for the first part of the operation, that of cutting hospitals, much less so in the second, that of the development of a capillary and functional territorial assistance.

This programming choice, moreover, has over time taken on the characteristics of an iconoclastic battle against the very image of the hospital seen as an obsolete and anti-historical place of institutionalization of the patient, resulting in dramatic choices for entire communities that have often seen themselves deprived of health facilities that although small and obsolete they were part of the life of those territories.

Mind you, there is no doubt that the Italian hospital network needed to be rethought, structurally and technologically modernized and that some hospitals were too small and insecure to keep up with the progress of science and medicine, too, but it is certain that what has been fact (except perhaps in large cities where substantially, except for some illustrious beheadings, the hospital map has remained unchanged if not implemented) has more the appearance of a clean slate than of a careful reprogramming of the healthcare offer in an integrated, complementary and unitary vision of care from the family doctor to the high-tech hospital.

This imaginative and often declaimed link that should see the patient at the center of a synergistic process of management between the different levels of care has in fact remained purely theoretical and, in short, the result today is that we have fewer hospitals and in any case “little” territory.

Then came the pandemic and our reduced hospital network, depleted of resources and personnel, desperate, not connected to the rest of the health system, risked going haywire.

And so also the hospital has fully entered into the investment programs of the NRP with a part of the funds reserved in particular for the structural and technological modernization and for the safety of the facilities.

But, while for the territory the Pnrr provides for a reform of territorial medicine (albeit with its lights and shadows which we have talked a lot about in several articles on QS) for the hospital we have not found a similar reforming design and in substance it to intervene on a hospital network that is unchanged as regards its fundamental principles and structures.

In our opinion, we have already written it, this is a mistake because the maxi funding of 8.6 billion from the NRP reserved for hospitals and technologies should be accompanied by a reorganization project of the hospital system designed in synergy with what is expected for the territory but above all also able to completely redesign the Italian healthcare network in its characteristics and purposes.

From these considerations made together with his friend Ivan Cavicchi, the idea of ​​this new “Forum” of Qs (opened today by Cavicchi) was born, dedicated to the hospital of the future seen, first of all, by those who work there in hospitals and then doctors, nurses and all the other operators and their scientific, ordinistic and trade union associations.

But like all our Forums, this is also open to the contribution of all our readers who want to participate in the discussion by sending us their opinions and ideas.

We are waiting for you, as always.

Cesare Fassari

June 14, 2021
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