By Denis Solomon
October 18, 2004
Minister of Health John Rahael says that "patients can now go to [Mount Hope] and receive emergency surgery at no cost". This reminds me of the saying that a bank is a place that will lend you money if you can prove you don't need it. Surely if you can "go" to the hospital you can't need any kind of surgery that could be classified as emergency.
Provision of decent and affordable health care is a difficult task for any country. The USA hasn't managed it. Ask Hillary Clinton. And the proof that cost is not the only obstacle is to be found in the excellent health service of impoverished and economically blockaded Cuba. Ask Patrick Manning.
Trinidad and Tobago shares one of the shortcomings of the USA in this regard: the unquestioned belief that a medical degree must be a ticket to wealth. This is a cultural, not a material, factor, and those countries that have been successful in this area have managed to overcome it.
Not that doctors need be paupers. Here in Italy they make a decent living, but they are regarded, and regard themselves, not as tin gods but as functionaries in an accepted system. Private practice is a rarity. Family doctors are paid by the state according to the number of patients on their list, clinical specialists according to the level of their work. The state meets the cost from revenue.
There, of course, is the rub. As the population ages, the tax base shrinks and the beneficiaries increase in number. Recently the centre-right Italian government introduced legislation to raise the pensionable age, and there is talk of increasing the contributory element in the pension system. The centre-left opposition objected and organized street protests, but had no alternative to offer.
In a previous article in this series I praised the Italian social welfare system. Well, I stick by that: it is admirable because free education, health care and pensions are admirable in themselves. Like affordable housing, they are not only a sign of wealth and good planning, but a mark of civilisation. But in the face of increasing cost, wastage and abuse have become a more and more serious concern. And since this is Italy, the wastage and abuse have a particularly Italian character.
For example, some people have several pensions. An old lady might have her own and part of her deceased husband's retirement pensions, his veteran's pension, and a disability pension if she is handicapped. In some parts of Italy she will probably also live in a rent-controlled council apartment.
All this is legal, but many of the abuses are very illegal indeed. Assisted, presumably, by corrupt civil servants, some healthy people enjoy pensions for partial or total disability. From time to time there is a purge, and some amazing stories come out. One man who was receiving a pension for total blindness was found to be working as a school bus driver. Another with the same pension was found out when he was stopped for speeding on his motor-scooter. And some people contrive to draw the pensions of dead relatives for many years.
This situation has given rise to a joke (perhaps several, but this is the only one I know). A pensioner tells his wife that when he went to collect his pension he realised that he had forgotten his pension book. "So I had a good idea", he said. "To prove that I was of pensionable age I opened my shirt and showed the lady that I had white hair on my chest, and she gave me the cheque". "Why didn't you open your trousers?" the wife asked. "Then you could have got a disability pension too."
To be a citizen of a country with a solid welfare system must be very reassuring. But some say it induces an unhealthy attitude of dependency.
People not only take the services for granted but feel cheated if they are not using them to the full.
Italians, already a nation of hypochondriacs, rush to the doctor or the casualty department at the slightest sniffle or twinge. In the small village where I live the doctor's office is regarded as a nice place to lime, especially in the winter. And this attitude seems to be encouraged by the system itself. Once you are in hospital they seem in no hurry to get you out. When I was operated on in Trinidad for inguinal hernia I spent one night in the clinic and was discharged the next morning. This is normal. An Italian friend spent a full two weeks in hospital for the same operation.
There are a few slack doctors, too. These do not, as in Trinidad, fail to turn up at the clinic because they are making money elsewhere. They simply don't turn up. However, the response of the authorities is somewhat more robust here.
Recently, faced with an unusual degree of absenteeism among hospital doctors, the mayor of one city did not call for emergency talks with the Medical Association. He simply sent the police to the doctors' homes to drag them to work, and charged them with breaching their contract with the municipality.
As far as I can tell, overall the work of Italian health personnel is efficient and the techniques up-to-date.
But mistakes do get made.
A recent spectacular one occurred when a hospital lost a patient's skull. Well, not his whole skull, but a chunk of his cranium. This had been removed for a brain intervention to get him out of a coma. When the operation was over the surgeons found that the item, instead of being stored wherever bits of skull are stored, had been thrown out with the refuse. In the enquiry that followed, the surgeons said that the piece of titanium they had substituted was in fact better than bone, but that the whole thing was irrelevant, since the patient died anyway.
Copyright © 2004 Denis Solomon