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LA RESPONSABILITÀ E L'UTILE DELLA SALUTE | La città del secondo rinascimento

LA RESPONSABILITÀ E L'UTILE DELLA SALUTE

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Immagine: 
Qualifiche dell'autore: 
ricercatore, dirigente di struttura sanitaria, membro dell’Associazione culturale Progetto Emilia Romagna

Il dibattito sulla scelta, politica e individuale, tra sanità pubblica e sanità privata è molto antico. Nel periodo mitologico della cura della salute in occidente si portavano gli ammalati sulle isole e in altri luoghi considerati sacri e dedicati ai culti di dei come Apollo e Asclepio, e l’idea di miracolo era prevalente. In tale periodo l’offerta alla divinità era la modalità in cui interveniva un pagamento. La figura del medico comparve in epoca successiva. Presso i Romani l’acquisizione e il mantenimento della salute erano un fatto prevalentemente individuale, di scelte di stili di vita con responsabilità nei confronti della comunità e dello stato. Il medico fu a lungo soprattutto un consulente, empirico all’inizio. Il pagamento, chiamato “onorario”, era un elemento fondamentale della cura, in quanto preservava la responsabilità di ciascuno verso la propria salute e la comunità. La creazione successiva delle “medicatrinae”, antesignane delle odierne case di cura, consentiva un ricovero regolato da pagamenti. L’immensa portata del cristianesimo cambiò radicalmente anche l’approccio alle questioni della salute, della cura e della malattia, sostenute ora dall’idea di “misericordia” verso chi si ammalava e di obbligo morale all’assistenza, con la creazione di grandi luoghi di ricovero retti da confraternite religiose, con privilegio del ricovero sulla cura. Con l’imporsi del primato dello stato sui vari aspetti della vita civile, gli ospedali sostituirono progressivamente i luoghi di ricovero, introducendo le imponenti acquisizioni della scienza medica ma, come quelli, continuando a esautorare, per moltissimi aspetti, le decisioni di chi è oggetto di cura. Contemporaneamente è risorta la cosiddetta sanità privata, poi convenzionata. La questione della cura come prassi privata o pubblica è, dunque, antichissima. Le attuali crisi delle economie di mercato e delle finanze pubbliche con conseguente retrazione costante del welfare impongono ora decisioni differenti riguardo alla salute. Se le strutture pubbliche e soprattutto quelle private stanno dando prova di un’assunzione di responsabilità con il contenimento del lucro e l’introduzione della “medicina low cost”, con pagamenti ridotti delle prestazioni, soprattutto di quelle ambulatoriali, occorre una riassunzione di responsabilità anche da parte di ciascuno riguardo alla propria salute. Pur rivolgendoci sempre al massimo della qualità espresso da sanitari, strutture e organizzazioni, d’ora in avanti dovremo considerare che pagamenti sostenibili dagli utenti non creano utile solamente agli operatori e alle strutture che li ospitano, ma, intesi come investimenti, diventano utile anche per ciascuno di noi, in termini di minori tempi di attesa, minori dosi di farmaci da assumere per un più precoce affrontamento dell’eventuale patologia, maggiore facilità ad instaurare “dispositivi della salute”, basati anche sulla parola, con i medici e gli altri operatori cui ci rivolgiamo. È un dibattito appena agl’inizi, su cui torneremo più volte, perché riguarda il futuro, anche della nostra salute.


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