If doctor families limit the number of tests and analyzes prescribed to patients and receive a financial bonus at the end of the year. Told like this, the story raises more than a few eyebrows. This happened in Emilia-Romagna, more specifically in the health services company Modena, where an agreement was signed with Fimmg (federation of general practitioners) granting “1.2 euros per patient per year” if they maintain performance requirements within certain thresholds. This concerns, among other things, operation vascular, dermatology, physiatry, gastroenterology, ophthalmology, ENT, pneumology, urology, CT scan, magnetic resonance imaging, gastroscopy and colonoscopy. The goal is to limit expenses and reduce costs waiting list.
TARGET
Director of the Local Health Authority of Modena, Mattia Altinimade the following summary: «The goal is not to encourage doctors to prescribe less indiscriminately, but to provide the tools and data to prescribe better, encouraging them to be virtuous’. The case sparked a reaction from the Fratelli d’Italia, which raised questions with the regional council of Emilia-Romagna. Even the CGIL, CISL and UIL trade unions are against it: “Conditioning of economic exchange is unacceptable.”
Province Modena The population is only 700 thousand people, but the health company’s move sparked national debate because the problem of waiting lists and useless prescriptions does exist, although Emilian’s solution, according to some observers, may not be the most far-sighted one. Health Minister Orazio Schillaci also spoke about the epidemic of discrepancies in an interview with Messaggero a few months ago. He explained: “We are seeing a clear increase in the number of prescriptions. We must ensure that every citizen has access to the tests and visits they really need and that they get them at the right time. Doctors, often under pressure, are making visits to protect themselves from potential complaints.” And in September, to limit what is defined as “defensive medicine”, a provision was passed on the protection of doctors in the event of complaints.
RESEARCH
There is also data on the burden of inappropriate visits and tests prescribed by general practitioners. The percentage, according to various studies, varies between 30 and 40 percent. For example, in Puglia different types of prescriptions were checked using artificial intelligence (CT scans, magnetic resonance imaging and ultrasound scans) and it turned out that only 39 percent of requests were “fully appropriate”, 43 were “inappropriate” and the rest were defined as “partially useful”. The President of the Italian Society of Radiology, Nicoletta Gandolfo, commented: «For every ten diagnostic imaging tests, four tests are inappropriate or, simply, useless».
That general practitioners he finds himself prescribing more tests or visits than necessary because he may be pressured by patients, but too many services crowd out his waiting list. Therefore, is the solution to pay more to doctors who prescribe fewer prescriptions? The President of the Modena Medical Association, Carlo Curatola, when asked by a local news site (LaPressa), answered with “no comment”, recalling article 30 of the code of ethics which states “physicians avoid all conditions of conflict of interest in which professional behavior is subordinated to economic or other undue advantage”.
STRATEGY
From the Emilia-Romagna Region they explained to Messaggero: in fact this model is not new here, in several Emilian provinces (Piacenza, Parma and Reggio Emilia) it has been implemented in recent years. And this, according to Regional, guarantees better spending results compared to the provinces of Romagna (but also Bologna and Ferrara) which do not implement it. Not only that, this formula has also been used in other areas. For example in Veneto, by 2023, there is an agreement to provide incentives to doctors covering the costs of tests and medicines. “This is not an incentive to prescribe less, but better”, said Emilia-Romagna health policy council member Massimo Fabi.
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