Italian doctors strike over threat to break up state health serviceBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7446.976 (Published 22 April 2004) Cite this as: BMJ 2004;328:976
An estimated 90% of GPs working in Italy's national health service took part in a one day strike on 16 April to protest about the government's proposed devolution of the service.
But doctors say that devolving power to the regions would result in 21 small and under-financed regional health services, which would widen inequalities and compromise overallefficiency.
“Better to go a few days without your GP now than risk spending the rest of your life without one” was the slogan coined by Dr Mario Falconi, secretary of the Italian Federation of General Practitioners (FIMMG), to which most of Italy's 54 000 family doctors belong.
The president of the National Federation of Medical Boards, Dr Giuseppe Del Barone, has also sided with the protesters. “They are striking for absolutely legitimate reasons. Payments are uncertain, waiting lists are getting longer, contracts are not being renewed and the cost of drugs not reimbursed to patients is continuously increasing,” he said.
Last Friday's protest was not the first, nor was it limited to family doctors: community paediatricians and emergency care doctors also took part. Today, hospital doctors and managers and private specialists working in the national health service were due to join a national march in Rome. This will be the fourth time that Italian doctors have gone on strike since last November.
Most patients have backed the strikes. “Parents thanked us,” explained Dr Pier Luigi Tucci, president of the Italian Federation of Paediatricians. “They have understood that we oppose the idea of… children being totally taken care of in one region but neglected in another.”
But health minister Girolamo Sirchia tried to reassure doctors and patients. “There isno reason to fear that the transfer of responsibilities to regions will introduce inequalities in health care,” Dr Sirchia said. “When devolution is approved, nothing will happen, as regions will have to respect national standards,” he added.
But doctors were also striking over their national contracts and the agreement that defines the role and per capita fees of GPs working for the national health service. These expired in 2001 and have not yet been renewed.
Meanwhile, the government is trying to combine general practice and paediatric services into primary care units providing 24 hour cover. The main doctors' unions differ in their responses to the move, with the Sindacato Nazionale Autonomo Medici Italiani totally opposed, while FIMMG is demanding an increase in per capita fees, on the grounds that the new system will require additional investment and will increase workloads.