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spese sanità

“Scalpel”, “here it is, Doctor,” “but it does not cut.” It is not the sketch of a comic vaudeville, but a real situation Italian surgeons face more and more often, forced to work with poor tools, sometimes even risky for the patients. The Italian Association of Hospital Surgeons “ACOI” after repeated reports coming from doctors around the country. The new scalpels made available to the white coats are of “poor quality” and increase the risk of provoking cosmetic damage or contracting infectious diseases in the operating room. An insult to the patients and taxpayers who support public health service with their taxes.

This case reminds us on another case that happened in the past and concerned diabetics. Then, loads with Chinese equipment for measuring blood glucose, which were out of order, made many patients end up in the emergency room. Diego Piazza, ACOI President, explains what happens: “Increasing the degree of the skin trauma to cut an area, we increase the risk of bacterial contamination of the wound. It is clear that, having to apply more force to cut a surface, we run the risk of cutting deeper than intended.”

What is the origin of this paradoxical situation? Less funds for medical care compelled the competent bodies to seek low-cost products and neglect quality. This choice turned out to be shortsighted. “It is an uneconomical choice – Piazza said – because a surgery may require the use of several scalpels. It would not happen with a good scalpel, which, on the contrary, can be used more than once during the same surgery. It is possible to make a cut with a poor-quality scalpel, but sometimes we use up to three scalpels for one surgery. The most serious problem is when the quality of high technology is too poor in cases when the patient’s life itself may depend on it, for example, in surgeries on heart valves.” Doctor Francesco Corcione, President of the Italian Society of Surgery denounced a similar situation too. He reported a problem with such a “basic” equipment as gloves that are so thin and fragile that doctors have to use two pairs of them together.

People will say: this optimization is part of a wider maneuver that reduces public expenditure. Yet, the directives of the spending review are far from being always respected. On the one hand, we save money on scalpels and gloves, on the other hand, the health system of some regions faces overspending (with 800% peaks for nursing homes) for products such as needles, gauze, syringes, and prostheses. Below you will find a few examples cited in Public Contracts Supervisory Authority’s last report. The purchase of a sterile syringe should cost to a local health authority or hospital no more than 2 eurocents, not 65 as it happens in some parts of the Italian Peninsula. Whereas the price of patient’s daily meals should not exceed 9.40 euros, and the only meal of the employee should not exceed 4.62 euros.

The gap between the North and the South of Italy is shocking. Using the example of an insulin syringe again, it turns out that it costs 4 cents to a hospital in the North of the country and up to 24 cents in the South. They may save on laundry service, without exceeding the outlay for every patient, which is 3.50 euros per day. More than that. A screening carried out by AGENAS and the National Agency for regional health, which analyzed the tenders of the past few years, brings to light needles paid from a minimum of 9 cents to a maximum of 25 euros. The same study found disposable staplers paid from 188 to 520 euros, cotton gauze paid from 2.89 euros to 7.47. Some hospitals pay 284 euros for a hip prosthesis, whereas others spend 2,575 euros for it, with a difference of 806%. For exactly the same products. Let us not forget about coronary stents that can cost 150 or 669 euros. Who cares as long as long as taxpayers pay for everything… if they manage to survive after surgeries performed with blunt scalpels.

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