“We need to make a serious cultural effort to understand what a Hospital is: it is not a factory, it is a different thing.”
These words, pronounced by the Minister of Health, Mr Gerolamo Sirchia, at the ‘2003 Future Health Forum’ held in Cernobbio on 26 March last, emphasise all the inconsistencies involved by the current legislation that, by converting hospital facilities into Enterprises, has in actual fact shifted the focus of attention from patient treatment to balance sheets.
As things stand at the moment, Hospital management could be handled by a marketing expert who, just as in a supermarket, would be exclusively interested in the bedspace financial productivity chart rather than in the quality of the service supplied. As in some kind of assembly line, in which beds become like some sort of pallet which patients are expected to occupy with record-time turnover performances, the purpose is to attain maximum productivity to ensure we can balance the Hospital accounts.
Whereas, in family medical assistance provided within the NHS, the system is trying to introduce expenditure budgets to control medical services, in hospital medicine the concept of financing Hospitals based on pathology category has established itself in grand style.
The fact that the Minister Mr Sirchia decided to emphasise this reality which is under everyone’s eyes and which represents the leitmotif of debates now taking place in all Italian hospitals, is a clear sign that the situation has now become no longer acceptable.

”I shall keep reiterating this point because, even though I used to be one of those who believed in the business managerialisation of Hospitals, when I realised that the Hospital mission had changed and that today we are taking greater care of balance sheets rather than of patients, I no longer like this concept”, the Minister said.

But what recipe do we need to cure this anomaly, which has so strikingly grown ever since the system introduced the concept of business managerialisation of hospitals and of healthcare facilities as a whole, where the saving management concepts typical of business organisation structures are imposed?
The operating rules regulating such activities are not based on the concept of curing diseases or treating patients.
The system underlying the well-known D.R.G.s (diagnosis related groups) tends to eliminate the payment of hospital fees depending on the length of the stay and on the medical service provided to individual patients admitted into Hospital, but it prescribes healthcare expenditure control through a representation of all hospitalised patients in terms of diagnoses, performed procedures, periods of stay and costs born. Of course we cannot pretend not to realise that, ever since this system was introduced, there has been a radical change in the type of assistance provided in Italy to patients, since these have from that time on become the financial hinge on which the whole Hospital economy turns.

“How can we properly run a Hospital? I do not have the recipe for this problem, but no doubt the recipe that has been proposed is not the right one or else it is only partially effective.
Reflection, serene agreements, debates without taking issues personally, acknowledging that people’s basic interests have priority over our own, are all attitudes that can assist us and help us. If we viewed people’s rights not as an abstract claim but as a value under our eyes, and we reviewed our position in the light of such a value, I feel that we would not only be able to attain an improved future healthcare system compared to today’s, but we could also provide a contribution to the system’s ethics and moralisation, which is always welcome.”

These were the closing words of Mr Sirchia’s speech at the ‘2003 Future Health Forum’ held in Cernobbio. It is quite obvious that the system cannot continue to simply rest on corporate balance sheet parameters, as it also needs to be supported by other principles, aimed at qualifying the professionalism of healthcare workers, so as to be able to assess their commitment based on the results of their treatments and not on the fact that the accounts balance according to a theoretically devised system.
In Germany there also is a drive to introduce the criteria which are currently in use in Italy, but German hospital medical doctors are objecting to a system ruled by purely financial criteria, and claim that this would worsen the quality of treatments and in the end the victims would be the patients themselves.
In Italy many hospital doctors have become demotivated as far as their activity is concerned, having to daily undergo assessments of their work which are entirely based on the balancing of accounts and on regional reimbursements; they are hoping that a new system may soon be introduced to reward results, scientific and human qualifications, research and certainly not the fact that their intervention may have, or may have not, involved a credit balance for the Hospital.
Translated by interpres sas