Italian healthcare, the Italian national health service, servizio sanitario nazionale, italian hospitals, medical treatment in italy
quality of medical services in italy, health system italy

Principles of the Servizio Sanitario Nazionale (Italian National health Service)

Human dignity
Every individual has to be treated with equal dignity and have equal rights regardless of personal characteristics and role in society

Protection
The individual health has to be protected with appropriate preventive measures and interventions

Need
Everyone has access to heath care and available resources to meet the primary health care needs

Solidarity
Available resources have to be primarily allocated to support groups of people, individuals and certain diseases that are socially, clinically and epidemiologically important

Effectiveness and appropriateness
Resources must be addressed towards services whose effectiveness is grounded and individuals that might especially benefit from them. Priority should be given to interventions that offer greater efficacy in relation to costs

Equity
Any individual must have access to the health care system with no differentiation or discrimination among citizens and no barrier at the point of use.

Healthcare in Italy
The Italian health system has been ranked second best in the world by the World Health Organisation, with only the French system ranked higher.

Although the Ministry of health is ultimately responsible for the administration of the Health Service, much of the control has been passed to the Regions and onto the local health authorities known as ASL (Azienda di Sanità Locale).

The Italian national healthcare service (SSN) was created in 1978 to replace a previous system based on a multitude of insurance schemes. The SSN was inspired by the British National Health Service and has two underlying principles. Firstly, every Italian citizen and foreign resident has the right to healthcare and, secondly, the system covers all necessary treatments. Local Health Units (USL) are responsible for the management of all health services in their area and private providers can also operate within the SSN.

The SSN encountered a number of financial problems from its inception. Firstly there was very little coordination of healthcare services at national level. More importantly, there was dissociation in financial control. The authority to spend rested with the USLsbut the responsibility to pay was still with the State. The result was continuous growth in expenditure and budget overruns.

There have been a number of reforms to the SSN since the early 90s. Competition has been increased by allowing citizens to choose their healthcare provider. Payments have been regularised using a Diagnostic Related Group (DRG) system and a small amount of co-payment has been introduced. Later reforms were aimed at increasing planning at the regional level and increasing efficiency of all managers within the SSN. Managers were placed on fixed contracts with regular performance reviews.

The latest reforms are aimed at reining in expenditure and improving planning. In the future, regions which overspend will be subject to automatic increases in regional taxation. In addition, extra resources are to be deployed to redevelop medical facilities, bolster technical innovation and reduce the North/South divide.

Current Italian healthcare expenditure is 9% of GDP, up from 5% in 1980. Besides the persistent levels of endemic over-expenditure, the Italian government will face three major problems over the next 30 years. Firstly, the shrinking working population will produce less tax revenue. In the short term this is worsened by a sluggish economy.

The second problem is the aging population. A better environment and improved medical techniques have both resulted in people living longer. The final demographic predicament is the low birthrate, which is well below the level needed to maintain the current population.

The ageing population will require new facilities to deal with the physical and mental diseases associated with old age as well as an increase in nursing homes to deal with end of life care.

The options available to the Italian government are few if they wish to maintain current healthcare standards. The working population can be increased through immigration and raising the retirement age. Overall taxation will need to be increased. Private healthcare expenditure may also rise, to pay for services which the government can no longer afford. (Source: Walnut Medical)

Italy Basic Health Statistics - Source: World Health Organisation
Indicator	Date	Value
Mid-year population	2008	59,832,180
% of population aged 0-14 years	2007	14.05
% of population aged 65+ years	2007	19.99
Live births per 1000 population	2007	9.51
Crude death rate per 1000 population	2007	9.65
Life expectancy at birth, in years	2007	81.70
Life expectancy at birth, in years, male	2007	78.84
Life expectancy at birth, in years, female	2007	84.35
Estimated life expectancy, (World Health Report)	2004	81
Estimated infant mortality per 1000 live births (World Health Report)	2004	4
Infant deaths per 1000 live births	2007	3.47
SDR, diseases of circulatory system, all ages per 100000	2007	179.11
SDR, malignant neoplasms, all ages per 100000	2007	163.72
SDR, external cause injury and poison, all ages per 100000	2007	28.51
SDR all causes, all ages, per 100000	2007	511.67
Tuberculosis incidence per 100000	2007	4.54
Hospital beds per 100000	2006	393.90
Physicians per 100000	2006	385.41
In-patient care admissions per 100	2006	14.46
Total health expenditure as % of gross domestic product (GDP), WHO estimates	2005	8.9

Healthcare Expenditure
Total healthcare expenditure was €106,505 million in 2008. €57,247 million was devoted to hospital inpatient care, divided between public (€47,736 million) and private (€9,511 million). A further €13,497 million was spent on prevention, ambulances, blood distribution and other services. The expenditure on pharmaceuticals amounted to €11,208 million.

Numbers of Hospitals per Region
Region	Acute	Psychiatric	Day Case
Abruzzo	34	0	0
Aosta Valley	1	0	0
Basilicata	17	0	0
Calabria	74	5	0
Campania	137	7	2
Emilia-Romagna	104	7	1
Friuli-Venezia Giulia	27	0	0
Lazio	206	17	2
Liguria	38	1	0
Lombardy	194	7	17
Marche	46	3	0
Molise	10	0	0
Piedmont	108	9	0
Puglia	111	3	2
Sardinia	46	0	0
Sicily	137	8	3
Tuscany	81	3	1
Trentino-Alto Adige	37	0	1
Umbria	24	0	0
Veneto	86	6	0

(Source: Walnut Medical)

Registering for healthcare in Italy