Italy’s national health service
Italy is one of the healthiest nations on earth. This is in part attributable to the benefits of the Mediterranean diet. In this vegetables and fruit, olive oil and fish predominate, while sweet food and meat are eaten in limited amounts.
Life expectancy is the fourth highest among OECD countries (83.4 years in 2018). It is the world’s eighth highest (82.8 years in 2018) according to the World Health Organisation. By most indices Italy also has one of the best national health services in the world.
A WHO report in 2000 listed Italy as second globally, after France. However in 2021 a health care ranking (CEOWORLD magazine) placed South Korea first. Then followed Taiwan, Denmark, Austria, Japan, Australia, France, Spain, Belgium, with the UK tenth and Italy at number 37. Obviously it all depends on the questions asked and the categories of statistics employed.
In Italy, health care is delivered, as in Britain, through a combination of public and private systems. The national service, or Servizio Sanitario Nazionale (SSN), was established through legislation in 1978 along with structural reforms introduced by the Government, then led by the Christian Democrats. The service is based on regional organisation under the aegis of the Ministry of Health.
There are considerable regional differences in both morbidity and the performance of the system. The national service, which in 2012 accounted for 9.2% of GDP, is funded from corporate tax and VAT. In an OECD study of 2010 this figure was exceeded only by France, Germany and the Netherlands, with the UK following at approx. 8.5%. The universal coverage is for all citizens and legal foreign residents and is provided free of charge.
People who do not register must take out private health insurance. Everyone registered holds a “Tessera sanitaria” or Health Card. The SSN covers the cost of hospitalisation and treatment, visits to family doctors and specialists, discounted medication, laboratory services, and ambulance provision, while dentistry is excluded. Even so, many Italians also have supplementary private health insurance.
Family doctors and prescriptions
Patients can choose and change their family doctor, subject to availability, based on information supplied by the local health authority. GPs, who are paid entirely by the SSN, have a limit of 1 500 patients each and must offer appointments on at least five days per week.
Prescription drugs are acquired at a chemist’s shop – farmacia (identified by an illuminated green cross when open) – and are generally subsidised. But in some cases they may require a contribution from the patient, depending on medicine type and patient income. In many regions all prescribed drugs are free to the poor.
Consultations with specialists and diagnostic tests are provided both at public hospitals and at private diagnostic centres in major cities. (These are like hospitals but without the wards). Needing to visit a diagnostic hub in Turin, I discovered that it was possible to communicate by email. And thereafter I could phone the specialist on his mobile – very welcome forms of accessibility.
In normal (non-Covid) times, the waiting time for a hospital appointment may be months in the public sector or weeks at a private establishment. GPs request prioritisation in urgent cases. Attention for emergency cases is provided free (even for undocumented non-citizens).
This explains the amazingly generous help given when, years ago before the UK’s membership of the EU, my mother tripped and fell one evening in Fiesole. A passer-by called an ambulance which whisked us off, up hill and down dale, to a major hospital in Florence. They were worried that she might have had a heart attack and wanted to keep her overnight but, being bouncy, she absconded from her hospital bed.
I returned next day and solicitously filled up forms and asked how much we owed; the question was cheerfully waved away but, while waiting in a consulting room, I was given the rare treat of an equally jovial political debate between two doctors of differing persuasions. It was election time!
Some hospitals in Italy are specialist units, as in maternity hospitals. There is also a network of recovery units or nursing homes within the SSN, providing specialist aftercare, for example following hip or knee replacement operations. As in France, the standard practice in Italy in these cases is significantly better than in the UK.
When a friend in Turin had her knee replaced, her surgical stay in hospital was followed by a long residence in a recovery unit with daily, systematic physiotherapy. Her husband said, “You can see how far Italy has sunk: she’s only getting a month when it should be two.” How I longed for care like that while trying to recover from my hip operation at home alone in a pandemic!
Calling an ambulance
The primary emergency telephone number is still 118, as the European number, 112, does not yet function in all regions. Ambulances in Italy come in different grades: basic, advanced (for critical care), mortuary, neonatal, and air ambulances. There are also patient transport vehicles. Ambulances are also provided by organizations outside the SSN, for instance the Italian Red Cross (Croce Rossa Italiana).
The service has an interesting history and in many towns some ambulances are run by volunteer-staffed charities descended from the very first communal medical assistance, created in medieval times by secular bodies attached to Catholic religious orders.
Such a body is still known as a Confraternita di Misericordia (Brotherhood of Mercy), though the volunteers may now be atheists or of other religions. In Florence the foundation is documented from 1244. There are still 700 of these groups in Italy and their ambulances respond to 118 calls in coordination with the national service. The ‘Misericordia’ also has other functions, including the provision of social and residential care for the elderly.
Recovery from Covid-19
Italy, as is well known, was very severely hit by the Covid-19 pandemic in its early stages in Europe, with horrific levels of pressure on hospitals and rates of mortality. Many courageous doctors and nurses died.
The exhaustion of personnel and depletion of resources must certainly loom large in the SSN, as in the NHS. One can only hope that it is better funded for its own recovery.