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© Jeff Matthews   entry July 11, 2016

Pigeons are the least of the problems

According to various sources, the Ospedale del Mare (Hospital of the Sea) is about to open. It is in Ponticelli, 6 km/c. 4 miles) from Naples in one direction and the same distance from Mt. Vesuvius in the other. They have to dot some i's, cross a few t's and get rid of the pigeons. (Indeed, 40,000 euros have just been handed over to a professional falconer to unleash his killer birds of prey on the poor widdle Doves of Doo-Doo that are already fouling the premises. Queston: Don't falcons ever have to go?) When it opens, it's not clear, at least to me, the extent to which the 500-bed new hospital will live up to original expectations.

The hospital was planned in 2003; construction started in 2006 and the facility was supposed to open in 2009. Only seven years behind schedule; that's not too bad around here. The real problem is that, one, it may have been ill-conceived in the first place and, two, the hospital management system within Italy as a whole has undergone great changes since 2003.

Number 1: originally the hospital was going to be one of the most important medical facilities in southern Italy and would have replaced at least some existing smaller hospitals in the area, rerouting staff to the new hospital. Still number 1: in the beginning stages of planning, no one seemed to notice that they were building a new hospital that is right next to Mt. Vesuvius and in an area that is perilously prone to earthquakes! It's too late, now. The place is up and ready to open. Defenders of the location say, yes, but we put in 307 seismic buffers. This is the only earthquake-proof hospital in the nation! (First, if the quake is big enough, nothing is earthquake proof, and, second, you forgot about the volcano.) It was astonishingly stupid to build that hospital where they did.

Number two: back in 2003 it was common to hear people say things such as “We have too many hospital beds in Italy. We have to economize.” A nation's ranking as a care-giver is based, at least in part, on the availability of hospital beds for the population (expressed as number of beds per 1000 persons). (There are other criteria: availability of health insurance, number of doctors and nurses, national promotion of health-improving activities, life-expectancy, infant mortality rate, occupational health and safety legislation, availability of private facilities, etc. etc., but “available beds” is a solid standard.) In the world at large, the rich and tiny little principality of Monaco on the French riviera ranks number 1 with 16.5 beds per thousand. Japan is also very high (about 13/1000). In Europe, Germany is relatively high at 8.3/1000. Italy is not; it is below the European average and is down at 3.82/1000 and aiming lower, at 3.7/1000. Thus, between 2000 and 2009, the available hospital beds were cut by 15% in Italy at large. Currently, there are 300,000 fewer available hospital beds in Italy than in the year 2000. Those Italian regions a bit above the 3.7 line will be expected to conform downwards. The Campania region (of which Naples is the capital) is below the standard and will be permitted to add beds.

Sounds good. The new hospital will fit right in. Not really. It's not that easy. The head of the National Association of Hospital Directors has called the entire affair of the Ospedale del Mare a sham, saying

People seems to think that the new hospital will solve all our problem. I assure you that nothing could be further from the truth. It might even makes things worse.

He follows with a laundry list of things that are wrong. Organizationally, there is no way the new hospital can be staffed simply by moving personnel from other hospitals. There aren't enough staff to go around, especially not enough appropriately trained ER staff to handle emergencies.

You don't just take a trained throat surgeon from the Second University Hospital in Naples and put him in an ER and ask him to fix up a guy who has ten slugs in him. [His exact words. He was upset.]

And you can't start closing good working hospitals, he said. And

They should turn this new one into an outpatient day clinic. [Also his exact words].

The bad news: it looks kind of bleak. The good news: Numbers aren't everything. It is very difficult to evaluate a national health system. The first (and only) attempt by the World Health Organization to rank the nations in the world using some of the criteria mentioned above was in 2000. It ranked France first and Italy second (out of 191 nations). The second-best health-care system in the world builds hospitals next to volcanoes! Curious in the report was that not one of the highly vaunted Scandinavian social democracies was in the top ten; Norway was highest at number 11. The report also showed the amount of money spent per capita on national public health care; interestingly, it is only marginally connected to the rating of the health care system, itself. France, rated number 1 overall was in 4th place in per capita expenditure; Italy in 2nd place was #11 in expenditure. The United States was rated 31st in overall healthcare but was in first place (!) in the amount of money spent on health care. And—I don't understand this—Canada was rated 30th in overall care (and 10th in expenditure), so the numbers are hard to interpret. The WHO report was so controversial that since 2000 the organization has not published another such report. But that's ok. That's probably what set off the move in Italy to “economize” in the first place.

Hey, we're number 2 in the whole world! We're spending too much on health-care. You know how many soccer stadiums we could build?”

I can't figure it out either.

[earlier entries here and here.]



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