Luckily It is not yet a bill, nor is it a measure about to start. The «points health card», which provides incentives such as ski passes and free entrances to the spa for those who accumulate virtuous behaviors in terms of prevention, is still only the boutade of Lombardy’s Councillor for Welfare, Guido Bertolaso, thrown as a provocation during an event and then taken up in an interview with ‘Lombardia Notizie Online’. In his words, the points card would be a tool to promote the health of citizens and achieve savings in the rising costs of healthcare, also due to the aging of the population.
Bertolaso focused above all on prevention understood as adherence to cancer screening, with only a very vague mention of any «lifestyles» to be taken into account in the score.And perhaps that’s for the best, although these are much more important, because they extend their benefits to cardiovascular, mental, metabolic health, and many other chronic conditions that weigh on the future of health and social care. But if he had pointed out these aspects that frightened Nicola Porro, with whom, for once, I find myself at least partly strangely in agreement, it would be even worse.
Do we want an ethical state?
In fact, the idea of the points card implies a concept of an ethical state, which punishes or rewards citizens in relation to their behavior, even when these do not directly harm the community. The topic has been much debated in relation to the allocation of organs for transplants: all other things being equal, is it right to implant the heart of a criminal instead of a good person? In a situation of limited resources, is it not right to allocate them to those who deserve them most?
Sometimes the line is thinner.Is it right to give a new liver to those who will continue to drink and also damage the organ that could have saved a person suffering from liver disease for which he has no responsibility? And again: why should the community pay the stratospheric cost of an oncological drug for a smoker perfectly aware of the risk he ran while lighting one cigarette after another?
The topic was also addressed during the debate on mandatory vaccination, before and after the pandemic. According to some, vaccination by law is justified only in cases where the procedure prevents contagion around them, while for others the damage to the community produced by the unvaccinated who crowd hospitals or otherwise use health services that without the disease could be used for others is also a sufficient motivation.
There is no doubt that, if we all followed doctors’ recommendations, wards and emergency rooms would be emptied and waiting lists would be shortened.But can you achieve this with a points card?
How do you control lifestyles?
Imagine a patient who smokes secretly from his doctor so as not to have his score lowered (or do we want to take advantage of technology to automatically record the purchase of cigarettes?) or lies, more than is already the case, sometimes in good faith, about the amount of alcohol he ingests every day. Indeed, given the government’s anti-scientific narrative, we would not be surprised if in the end a couple of glasses of wine at the table, instead of representing a risk factor, were rewarded by the system, such as the intake of red meat and cured meats, as long as they were strictly Italian and of quality.
And what about physical activity: how is it measured? By connecting apps on your smartphone to a central detector, or by integrating gym or pool entrances? The Internet of Things
Even in China, where for years there has been talk of a Black Mirror-style social credit system, which thanks to facial recognition allowed by artificial intelligence would take points away from those who run red lights and add them to those who volunteer, apparently, it doesn’t work quite like that.
This is why the councillor, in his interview, overlooks primary prevention and insists much more on the need to increase adherence to regional programs for the early diagnosis of breast, colon and cervical cancers, to which they want to add starting this year that of the lung and prostate (and of this idea, In the coming weeks, we will have to talk again).
Here, too, as with vaccination campaigns, there is an insistence on the responsibility of citizens before worrying about the offer that is given, and how it is communicated.
In Lombardy, screenings are not sweeping
On one point the councillor is right.For the three national programs included in the essential levels of care, even the rich Lombardy has unsatisfactory results with respect to the minimum objectives set: just over half of women between 50 and 74 years old accept the invitation to perform a check-up mammogram every two years and about 40% of people of both sexes undergo screening for colorectal cancer in the same age group.
These data refer to 2021, when there was an attempt to recover from the collapse in performance that occurred in 2020 following the impact of the pandemic, which focused all the efforts of prevention services on the emergency, inevitably neglecting less urgent activities.
The Covid-19 effect was even more pronounced on the third screening program, the one for the prevention of cervical cancer with Pap smear or HPV DNA test, which already in the pre-pandemic era was not actively offered to all Lombard women for whom it was provided.In fact, all those of the ATS of the metropolitan area of Milan (with the exception of Lodi), the ATS of Bergamo, Brianza and Insubria, which had not yet activated the program, were left out.
In the two-year period 2020-2021, only 15.7% of women aged between 25 and 64 received an invitation to undergo the test, and only in areas where the service already existed before the pandemic (ATS of Brescia, territory of Lodi, Pavia, Val Padana and Montagna). More than 45% of the (few) women called to perform Pap smears or HPV tests have therefore adhered to the invitation of the Public Service, even if the graph accompanying the text of the document reverses the data.
This does not mean that there are so few women in Lombardy who undergo these check-ups: most carry out the examination during periodic visits, often private, to their own or their gynecologist, thus paying for it out of their own pocket when they would be entitled to access the regional program.The same happens with mammography, which many doctors and private facilities suggest on an annual basis, often with an ultrasound in addition, although this is not provided by any guideline, other than the Chinese ones. The check-ups offered by companies and touted by private medical centers further supplement the rate of people checked. But all this takes place in a circuit parallel to that of public health, of which it is very difficult for Bertolaso not to be aware.
As when attacking the few true anti-vaxxers who refuse any vaccination a priori, it is easier to point the finger at the behavior of citizens than to make a serious self-criticism on the methods of offering and communicating the service to which they want them to adhere.
A system that benefits the privileged
It is to be expected — and right — that the points card also takes into account the checks carried out in private, but, if the invitations of the public service do not reach the whole population, it is clear that the system, once again, benefits those who would not need it.
That this is the mechanism is also clear from the premiums provided, designed for a small, already privileged segment of the population.Not shopping vouchers or priority access to some services useful to everyone, but ski passes, entrances to the spa, tickets for major events. This already says a lot about the distance between the councillor for welfare, who is also expected to pay attention to the social and health difficulties of citizens, and the world around him. How many Lombards are there who are old enough and able to go skiing and can afford the trip and possibly the stay in a ski resort «on the mountain areas that, in 2 years, will host the Olympics», or would they go to enjoy the spa «in one of our spas of the highest quality»? Or are they so interested in the «big events» to be done for these checks that they wouldn’t do otherwise?
The difficulty, in Lombardy and beyond, is to be able to do the tests prescribed by the doctor in a reasonable time for a serious reason. To the people who ask for bread, there is no need to offer croissants.
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Source — https://www.univadis.it/viewarticle/si-dice-villa-prevenzione-non-%25C3%25A8-tessera-punti-2024a10003bf