Federalismo in Italia: ma la salute non ha confini!

Federalismo in Italia e i nuovi diritti dei pazienti con la Direttiva europea sulle cure trans-frontaliere

A metà del 2013 entrerà in vigore in tutti i paesi dell’Unione Europea una nuova Direttiva sui diritti dei pazienti nelle cure transfrontaliere. Il federalismo in Italia in sanità abbatte i confini. Si tratta di una assoluta novità perché il testo prende le mosse da alcune sentenze della Corte di Giustizia Europea che riconoscono ad alcuni cittadini comunitari (quelli che avevano fatto ricorso) il diritto ad essere rimborsati dal proprio paese in caso di cure all’estero. In pratica l’Europa, partendo dal basso, vale a dire da una azione giuridica intentata dai cittadini, prende atto che non è possibile violare il diritto alla mobilità e alla libera scelta degli individui di ricevere trattamenti sanitari in ognuno degli Stati membri. Addirittura la libertà di movimento non riguarda solo le persone, ma anche i prodotti e i trattamenti, tanto che un cittadino potrà avere accesso a farmaci non ancora distribuiti nel proprio paese e, qualora sia il medico ad indicarne la necessità,  pagare secondo le modalità previste nel proprio paese.

Articolo completo su Civicolab  http://www.civicolab.it/?p=2830

English version:

Federalism, the Italian style, and “no-border” Healthcare (by Teresa Petrangolini)

In mid-2013, a new directive on patient rights in cross-border care will come into force in all EU countries. This is an absolute novelty, as the text takes into consideration certain rulings of the European Court of Justice which recognized some EU citizens (those who had made use of) the right to be reimbursed by their home country in case of treatment abroad. In practice, Europe starting from the bottom, ie. from a legal action brought by citizens, notes that it is not possible, for the right to mobility and the free choice of individuals, to receive treatment within each of the Member States. Even the freedom of movement not only affects individuals, but also products and treatments, in the sense that a citizen can have access to drugs not yet distributed in his homeland and, when the doctor indicates the need to pay as provided in their country of origin. Obviously, the Directive is much more complicated than that because it takes into account the compatibility of economic and spending limits, to avoid “bankruptcy” of countries whose citizens tend to resort to emigration in order to access health care of higher quality in neighboring States. The principle is interesting, however: healthcare has no borders, and has to struggle for a government and for standard rules. For example, people suffering from a rare disease must be able to access the best possible treatment regardless of their place of residence.

This vision of health care, intended as a global or, at least, public responsibility, has been making inroads in Europe for quite some time. It had started from food safety and now addressing the safety in health care. There is a strong focus on the sole management of chronic diseases, treatment of pain, and prevention of obesity, just to name a few. Common standards related to patients’ rights, as stated by the European Charter of Patients’ Rights, are now recognized as tools to ensure equal quality of care and equity in the access to services for European citizens. The trend is not just for the community. There is now a strong belief among international organizations, NGOs and health-care networks, that health must be built according to a global vision of the welfare of a society. This is one of the conditions for the development of mankind and one of the preconditions for growth, in a time of severe economic crisis, just as significant as labour and environmental protection. This requires policies and actions that exceed barriers at 360 degrees and autonomies that build partnerships, collaborations and synergies also in the collection and management of resources. Having said all this, we see a question-mark: where does Italy stand and which to direction is it going? The Extreme Federalism, which seems to be the current model in public health: is it a winning strategy or just a means to create discrimination, hiding flaws and preserving privileges, while it reduces the chances of access to quality care on the part of its citizens? What will happen in the Regions of Sicily, Umbria or that of Lazio, when in 2013 their citizens will ask to to be acceeded health-care, without waiting lists, in Austria or in France? How would they be able to compete, when they have no rules or common standards? In the United States of America, the largest Federal system in the world, some 90% of the decisions are taken at individual State level. Only a few matters are decided in Washington. One of these is the pharmaceutical policy through the work of the FDA (Food and Drug Administration). In Italy, despite the presence of a national agency, AIFA, some  21 regional handbooks were created, governed by their rules, barriers and discrepancies. Having a distant look around us, one would soon realise that there is something going wrong. If health is to be considered as a global phenomenon, why have we turned it into something partial and sectorial?                                           

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