Give a economic bonus to family doctor which prescribes fewer visits and tests to its patients, to lighten the burden on structures and reduce long waiting lists. This is a new strategy implemented by Modena local health authority. Now general practitioners affiliated with the Emilian healthcare company will be able to earn up to 2 thousand euros more per year by reducing the number of prescriptions. To be precise: 1.2 euros gross per patient for those prescribed a number of specialist tests that does not exceed the number ordered in 2024 by 25%.
A method first implemented in Italy, which has sparked a lot of controversy among the white coats themselves. So much so that the agreement with the local Health Department is directed by Mattia Altini it was only signed by one trade union, albeit the one most representative of the category, Fimmg. For Smi and especially Snami, the Modena agreement weakens the relationship of care between doctor and patient, raising doubts in the person being helped: isn’t he giving me a prescription because I don’t need it or because he wants to receive a financial bonus?
These provisions were born in context intense pressure on Emilian’s healthcare system. the same governor, Michele De Pascaleadmits that regional services have difficulty responding to residents’ needs, especially because of the existence of a continuous flow of patients from other areas of the peninsula. Economic incentives for those who reduce prescriptions are the response of the Regional Health Authority of Modena to this problem. According to the company, the goal is to reduce overconsumption and encourage more appropriate use of health resources, which are currently limited compared to demand. This is not about encouraging doctors to prescribe less, but rather to do so prescribe better, to improve the quality of services and ensure that services are provided to those who really need them.
But the result, according to critical unions, has been to encourage professionals to “jump on” the requirements, and what’s more, made the category a predictable target for media opprobrium. All up to a maximum of 2 thousand euros gross per year, depending on the number of clients. This relatively low figure cannot justify, at least from an economic point of view, the desire of other countries to sign the agreement.
Compared to what was intended, the content of the ASL resolution – which implements the agreement – has also been reduced. In the first draft submitted in August, in the middle of the holiday period, in order to get incentives, the white coats had to adapt to the performance “best player“, namely doctors who issued fewer prescriptions in the previous year. An element considered too extreme, which caused general dissatisfaction among professionals, convinced the parties to revise the text.
“The problem of pressure on clinics and hospitals exists and should not be ignored, nor should waiting lists, but this is not the way to solve it, for the first time applying very wrong principles and putting the relationship with patients in crisis,” he commented to ilfattoquotidiano.it Roberto Pierallipresident of Snami Emilia-Romagna. His union explicitly expressed dissent to the agreement: “From a legal point of view, this means that the agreement applies only to union members who have signed. Other professionals will not receive any incentives based on the number of prescriptions.”
This is a question of principle for Snami, whatever the amount offered. Deciding what to prescribe and what not to prescribe is the doctor’s responsibility and is part of his ethics. “Also because someone needs to tell us what is meant by an inappropriate prescription – commented Pieralli -. Because here no one says it, everyone talks about it, but no one explains what parameters are used to measure the principle of conformity. This agreement is based on a concept that even ASL cannot define and measure“. Sometimes, the President explained, doctors prescribe additional tests to dispel doubts. “If fortunately the results are negative, does that mean his performance is inappropriate?”.
Article “Fewer prescriptions, more money”: the case of the bonuses offered to doctors by the Local Health Authority of Modena. Union: “Problems cannot be solved like this” comes from Il Fatto Quotidiano.
