It can not be said that a public health system of a state or region (model "Beveridge") is always better than a private health care system of a state or region (model "Bismarck").
On the contrary, states or regions, in order to have an efficient and effective health service must put in place a model where public and private sectors are in competition with each other.
The ideological framework of Jeremy Rifkin sees three basic paradigms (energy, communications and logistics) complementing each other in a hierarchical and top-down economy, evolving distributively through cost-sharing economic systems. health care is a service, and as such tends to evolve towards the sharing economy and collaborative community (commons).
In the social model indicated by Jeremy Rifkin, can health services also be alternatives to the two historical organizational models of Bismarck and Beveridge?
Even for health services, it emerges that, to appropriately meet the growing and new health requirements, it is necessary to improve the economic system with the best cost/ benefit ratio and the lowest possible entropy. The new route also in health care is the development of the economy of sharing and the development of collaborative communities (commons) where the comparison between institutions, citizens and health specialists will be revolutionized by a new patient-citizen as an increasingly active element and aware of his rights. The intelligent digital networks for health will spread increasingly (Health Smart grid Digital).
The fundamental paradigms of intelligent digital networks for health, which set the new model, correspond to a complementarity between the paradigms of a Zero Zone oriented towards a society at a zero marginal cost, with Zero Disease turned towards an exponential contrast of the disease with an ideal trend of making it null.
| ZERO ZONE | ZERO DISEASE |
| ENERGY | HEALTHY BEINGS |
| COMMUNICATION | DOCTOR/PATIENT RELATIONSHIP (role of internet in prevention and prediction) |
| LOGISTICS | HEALTHCARE (management) |
Jeremy Rifkinâs prediction is applicable not only to the production of all goods and to all services but even more importantly to service excellence in the protection of health.
The paradigm of energy Zero Zone finds reciprocity with the maintenance of health (to be healthy), of zero disease .
The paradigm of Zero Zone communication finds reciprocity in the evolution of the doctor/ patient relationship through the development of the internet and the strengthening of preventive medicine and predictive zero disease.
The archetype of Zero Zone logistics bares reciprocity in the organizational model of health management (healthcare).
Even in healthcare a third way will come to develop through the use of specific energy elements (consciousness biospheric), communication (empathy, empowerment and assertiveness) and health care logistics; the health Commons or the sharing economy and collaborative communities (commons).
2. Historical evolution of healthcare assistance
2.1 From Hippocrates to the discovery of antibiotics
Hippocrates was born in Greece in 460 B.C. and died also in Greece in 377 B.C. He is considered the father of medicine. Treating disease and the sick has been a necessity formed with the very origin of man; as a spontaneous need of the patient to live in the community while not being alone against an illness. "Medicus" is not only the one who mediates between the patient and the disease, but also who stands between evil and death, often taking over the centuries a mystic or priestly role. The first medical schools were developed in the area of present-day Greece and Ancient Greece, including in Sicily and Calabria. In Crotone, Calabria, the school of Pythagoras (570 BC - 495 BC)9 was famous. At the center of the Hippocratic conception there was not the disease but rather a man with an extreme attention towards nutrition and the environment. This was the precursor of the knowledge of the first determinants of disease related to nutrition and healthy air. The writings of Hippocrates (or assumed so) were analyzed in the universities until the 1700. Such manuscripts were oriented towards prudence and caution before intervening with the moderate use of therapy also since in those days there were few remedies available, pharmacology was not yet known and herbal medicine was in its infancy, growing about a century later with Theophrastus (371 B.C. - 287 B.C.), a pupil of Aristotle (384 B.C. - 322 B.C.) to whom we owe an enormous boost of natural sciences.
Hippocrates gave medicine a holistic imprint centred on man and the environment, becoming in fact the precursor of the most advanced modern environmentalist theories, including the economic and ecological ones of our economist of reference, Jeremy Rifkin: our guide in describing the new paradigm of medicine that with this paper we disseminate: Zero Disease.
Hippocrates introduced the first concepts of medical ethics and it is to his school that the doctor's oath is attributed:
âI swear by Apollo the healer, by Asclepius, by Hygieia, by Panacea, and by all the Gods and Goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath: I swear to to honour like I honour my parents he who taught me the art of medicine (concept of pupil-teacher); to share with him my sustainment and satisfy his needs, if he may need it;
to consider his sons as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture;
to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physicianâs oath, but to nobody else (concept of caste);
I will apply the diet regime for the advantage of the ill, according to my ability and judgement, I will spread them against anything harmful and unjust;
I will not administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion;
I will keep pure and holy both my life and my profession. I will not operate on who sufferers from stone, and will leave such practice to professionals;
âInto whatever house I enter, it will be to help the sick, and I will abstain from all intentional corruption, especially from seducing women, men, free and slaves. And whatsoever I shall see or hear in the exercise of my profession as well as outside my profession that I can hear or see regarding the life of others that should not be divulged, I shall tacite, holding such things as secrets (concept of professional secret);
I carry out this oath all the way and honour it, may I be able to enjoy the fruits of my life and of this art, forever honoured by all men; but if I transgress it and forswear myself, may the opposite befall meâ.
Hygiene, from greek "salutare", is the branch of medicine that deals with health in a holistic way from its earliest conception that studies the wholesomeness of air, soil and water to its most modern conception that studies how to organize in public and private health care the health services as efficiently and effectively as possible. Hygiene has always dealt with how to prevent disease.
Democritus (460 B.C. - 370 B.C.) developed the theory of pores that came to condition the scarcity of hygiene that was found in the Middle Ages. For the school of Democritus, depending on whether the pores were open or closed, there would have been a condition respectively of relaxation or tension. According to this theory, it was necessary to try to maintain the pores naturally open with resulting attention on how to wash and on the water temperature. This concept was misinterpreted in the Middle Ages condemning water as a cause for the closure of the pores.
Fortunately, the erroneous theories of