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.
And you can't start closing good working hospitals, he said. And..."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.]
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, 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."They should turn this new one into an outpatient day clinic." [Also his exact words].
“Hey, we're 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.