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Perché ci si cura chiedendo finanziamenti quando con il Sevizio Sanitario non si dovrebbe pagare nulla oltre al ticket

Heartbeat

Heartbeat

di Luigi Ripamonti (Corriere.it)

Il contratto sociale in sofferenza

Sono sempre di più le persone che chiedono finanziamenti per pagare interventi chirurgici, cure dentistiche, farmaci, persino esami. È un fenomeno che può stupire, perché in Italia non c’è una propensione diffusa all’indebitamento e perché nel nostro Paese la salute è (o dovrebbe) essere in massima parte garantita dal Servizio Sanitario: oltre al ticket, per le cure necessarie non si dovrebbe pagare nulla. E allora perché ci si cura «a rate»?
Escludendo interventi estetici «veri» (non ricostruttivi) e cure odontoiatriche, che (giusto o no), sono tradizionalmente considerate «private», i motivi sono essenzialmente due: liste d’attesa troppo lunghe o mancata copertura da parte del Sistema Sanitario di alcune prestazioni o medicinali innovativi. Che cosa dovremmo dedurre? Che il sistema sia inefficiente o ingiusto? Inefficiente in alcuni casi (forse anche molti) è possibile, ingiusto probabilmente no. La risposta, meno demagogica, ma più realistica, è che il Servizio Sanitario si trova davanti alla cosiddetta triade logica inconsistente, cioè nell’impossibilità di ottemperare a questi tre obiettivi contemporaneamente: accesso di tutti i cittadini al Sistema; accesso per tutti a tutte le prestazioni; qualità ottimale di tutte le prestazioni. La coperta è corta: che cosa è meglio sacrificare? Accesso universale, totalità delle prestazioni o qualità?

Quello che è certo è che più si spreca, più tutti e tre i termini di questo «contratto sociale» vanno in sofferenza e più si crea lo spazio, e talvolta la necessità, di ricorrere alla singola iniziativa, che spesso ha costi insostenibili. Che cosa fare allora? Le soluzioni sono ovviamente materia per decisori politici e amministratori sanitari. La trasparenza nella spesa, la creazione di benchmark per le gare d’appalto che bilancino in modo trasparente e intelligente costi e qualità, la lotta alla corruzione e alla lottizzazione delle nomine di manager e primari sono solo alcune delle ricette da seguire. Ma anche ciascuno di noi è chiamato a un utilizzo sensato della preziosa risorsa che è il nostro Sistema Sanitario, magari evitando inutili «pressing» prescrittivi di terapie e diagnosi sui medici o, valutando razionalmente la necessità di chiudere di reparti o servizi che non garantiscono prestazioni adeguate, anche se questo obbligherà a qualche chilometro in più. Due piccoli esempi. Ma tutto serve. In altre Nazioni le ricette per mantenere l’universalismo del sistema sanitario hanno già comportato sacrifici ben maggiori di quelli per ora chiesti a noi.

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