17 July 1998
The ICB, conscious of the importance of the problem of “distributive justice” in the allocation of healthcare resources, has considered appropriate to create a comprehensive document with the contribution also of scholars not belonging to the ICB. The document is subdivided into two sections, one of a general nature, and the other a collection of scientific contributions on specific subjects by the various scholars questioned.
The ICB examines the issue of the allocation of resources, both at the micro and macro level, in the context of the healthcare system. It is a matter of establishing the portion of GDP to be allocated to the system and its distribution, both in terms of human resources (quantitatively and qualitatively adequate personnel) and material, structural and technological resources, among prevention, effective treatment of illnesses and the organisation of services, in the light of the principles of sociality, subsidiarity, solidarity and responsibility. The Committee analyses “incompatibilist” theories, for which economic efficiency and ethics are inevitably at conflict and “reconciliationist” theories, for which this conflict is not beyond repair.
In Italy - which is among the European countries with the lowest percentage of GDP allocated to healthcare - there is debate on State intervention, the Public-Private mix, the obtainable effects with the free market, and the so-called maximal market. The ICB proposes the accreditation of services and regionalization of responsibility, which also includes units of assessment with a warning not to accentuate regional inequalities. The “rationing” should not be interpreted as merely saving but as necessary intervention even if there were no fixed limit to expenses, it is a rational measure not cold rationalization.
In this framework the Committee considers it right to emphasise the importance invested in research and experimentation: resources in this sector would inevitably have repercussions on the system of healthcare and therefore on the very constitutional principle of the right to protect health. In addition, the Committee pays particular attention to the formation of personnel on the basis of a medical education aimed at achieving “total quality” care.
Lastly, the contributions of the non-members of the ICB have been gathered together under three headings: juridical profiles, healthcare and social assistance, life sciences research.