Garattini: “This is how we can save our healthcare system”

Garattini: “This is how we can save our healthcare system”


It is the last station to catch a train that risks never passing again. The fourteen luminaries of Italian science who signed an appeal to save the national health system are aware of this. “From 1978, the date of its foundation, to 2019 the NHS in Italy contributed to producing the most marked increase in life expectancy (from 73.8 to 83.6 years) among high-income countries – they write -. But today the data shows that it is in crisis: decline in some health indicators, growing difficulty in accessing diagnosis and treatment paths, increase in regional and social inequalities”. One of the signatories talks about it, Silvio GarattiniItalian oncologist, pharmacologist and researcher, as well as president and founder of the Mario Negri Pharmacological Research Institute.

Professor, why did you move? Why this letter-appeal?

“The purpose of our intervention is to try to put pressure on politicians. Because they seem to ignore the current state of negative situation in which the National Health System finds itself, a system that still carries out fundamental activities, such as major surgeries, anti-tumor chemotherapies and heart transplants. “organs, but which is giving way to the entire part that concerns visits, analyzes and diagnoses. This is demonstrated by the long waiting lists that we see every day. Very expensive”.

So a healthcare system in difficulty. But when and why did this air of crisis begin to blow?

“It was the SARS-CoV-2 virus, with the Covid infections it generated, that exposed the problems and set the system adrift. This is because, not being prepared for a pandemic, we used everything that was available to fight it and neglected the other part of medicine. In some way this highlighted the difficulties. And now, once the pandemic is over, it is difficult to recover”

Can you explain why?

“Because some fundamental problems are ignored. I’ll give you an example, the most striking one, on which many other things that are wrong depend: what we now spend on healthcare is too little, especially for healthcare workers, who are underpaid compared to the European average and therefore they go to work abroad or in the private sector. If nothing is done, the situation will only get worse.”

The risk, you say, is that we move closer to the US model, that is, to private healthcare.

“Exactly, the risk for Italy is precisely this. We are talking about a situation in which it becomes essential to have insurance to be treated. But only those who have money can have it, and let’s not forget that in Italy there are millions of poor people I lived for a long time in the period in which the NHS did not yet exist, I am talking about before 1978. My father, having my mother ill, was forced to take a second job to pay for the medicines. Let us remember that we do not pay for the medicines now and this is a great advantage compared to before, when health insurance only reached a certain point and then it was necessary to insure”.

You propose a recovery plan that starts from new financial resources. What does it consist of?

“It concerns first of all the problems we have in the area. It is impossible for a doctor alone to deal with a medicine that has become complex. The NHS should have, as with hospital doctors, who are regularly employed, employed staff. It should also have local doctors hired who work together in the community houses: 20 or 25 health workers who have specialists available. People don’t enjoy going to the emergency room, certainly if they could count on local help they wouldn’t queue. And if we had community homes with many doctors who coordinate in the clinics, we could cover the whole day, for the whole week, using telemedicine to communicate with hospitals and patients and very simple equipment to carry out analyses, without having to resorting to hospitals and wasting time. In Italy there are community houses that work, let’s take inspiration from them.”

So we should invest. But with what priority?

“The NHS should start hiring young people to work as general practitioners in community homes.
However, we must think that we will have fewer and fewer healthcare personnel. And it is not good to go and get it in Cuba, as is being done in some regions. The staff must be Italian to communicate with the patient. Why are new doctors decreasing? They are paid less and we have fewer and fewer young people. Many competitions are unable to hire the required number of staff, I am talking above all about complicated specializations such as anaesthesia, emergency surgery and intensive care. Furthermore, interventions on the structures would also be needed because many hospitals are dilapidated. PNRR money must also be used for this. But there is another problem.”


“Medicine has become a market. We have made progress with new drugs, but we have built a business. We have forgotten that the majority of diseases are avoidable. We have 3,700 thousand diabetics, and this can be avoided; 40% of tumors are avoidable; every year in Italy 180 thousand people die. So we must
changing the paradigm, i.e. putting prevention at the centre. This implies a cultural change, that is, we must prevent it: young people smoke, drink alcohol, are sedentary and have no social relationships, they are always on their cell phones. Prevention must also pass through them, it must become the main topic of medicine.”

But how long will it take to do all this?

“Some things can be resolved in the short term, even in three years. I am referring to the restructuring of the community houses. Furthermore, we need a health school in which to train managers, while in public schools we should dedicate at least an hour a week to health. If we don’t start, we will never see this new course. We must set examples so that they are contagious. Now there is no political will, and this is what we must work on immediately.”


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