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 Service 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 the local health authorities known as ASL (Azienda di Sanità Locale).
The Servizio Sanitario Nazionale (Italian National Health Service, or 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 a national level. More importantly, there was dissociation in financial control. The authority to spend rested with the USL, but 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 providers. 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 the 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.
Between 2005 and 2020, Italian healthcare expenditure varied between 8.1% and 9.7% of GDP, the latter being the latest recorded figure in 2020. This is greatly increased from 5% in 1980. Besides the persistent levels of endemic over-expenditure, the Italian government will face several 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 ageing 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.
In addition, the expenditure during the COVID-19 pandemic has placed far greater pressure on the Health Service, as the economy seeks to recover.
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 may also need to be increased. Private healthcare expenditure may also rise, to pay for services which the government can no longer afford. (Source: Walnut Medical)
