Life in Italy

Healthcare and hospital closures

October 5th, 2010: Sue Ardovini

Not long after landing in Italy, Enzo and I 'did the rounds' in order to visit as many family and friends as possible.  Over the dinner table we had plenty of time to catch up on issues that touch us all, national, international and local.

It was time for Enzo to discover the Italy he had no idea of.  Although Enzo was born in Italy, he spent most of his life living in America.  I remember wondering how he would find his new European life as during a memorable evening at dinner with friends, the conversation of health care came up in relation to the news that Ceccano hospital, our local hospital, is about to close.  The discussion evoked much emotion as each member of the dinner table threw their thoughts across the table.

It was then that we discovered just how little Italians pay to the Government for the provision of their health care.  Fifteen euros per month by anyone standards is a small amount of money, especially in a  country whose elderly population is growing faster than any other country in Europe. 

Protesting the closure of Ceccano Hospital

As part of a brave initiative, the Italian Government is proposing to restructure the health care system, (Servizio Sanitario Nazionale or SSN).   Unfortunately for the Lazio region, which is reported to be burdening the Government with 60% of the national dept, is set to lose 29 of its hospitals.  This is a long way from The World Health Organisation Report written in 2000 and subsequent study in relation to public perception by Vittorio Maio, PharmD and Lamberto Manzoli, MD.

The closure of hospitals in the region will be as disruptive as any large business that provides work and services to the area but with a difference.  As services are moved elsewhere Government run hospitals do not get replaced with more efficient services as demonstrated with businesses operating within a free market system.  The loss of jobs and services can ultimately lead to migration as people search to live elsewhere for their needs.

According to W. H. O report, Italy ranked second among the 191 countries studied, with France being the first.  At the time the U.S. health care system, which spends more per person on health care than any other country, was ranked 37th - last among industrialised countries.

The most pressing question to ask is what went wrong?  This from a paper by Janos Kornai in 2008: 'The soft budge constraint system in the hospital sector'

Renata Polverini, Govenor of the Lazio region, made promises regarding the present health system and maintained that there would be no hospital closures.  However during protests against the now imminent closure of many rural hospitals, Polverini stated that the new plan will bring "better health care."

Renata Polverini visits Ceccano hospital 2010

At the opening of the Traditional Grape Festival in Marinoon Sunday 3rd October, she went on: "we need a different health care system from the one we have had until now, because today's needs have changed.  They have changed both regionally in terms both urban and demographic.  There are different and new diseases that we treat and the plan is to provide appropriate responses."

Polverini went on to state "that she was sure over time the people will come to appreciate the plan as a whole and the reorganization of health services and hospitals. At this time the region is not the master as we shoulder 60% of the national debt."
As for the very critical position assumed by many mayors against the plan to reorganise the hospital network, Polverini reiterated “as I said, I will meet them and will also meet with citizens because I believe that we must all understand that right now we have the opportunity, for the first time, to really revolutionize our health care system and make it efficient in response to what people have asked of us."

According to Mario Abbruzzese, The President of the Regional Council, "we are at a crossroads, and it's time to decide.  The protests will only bring harm to the process.  I am the first to understand some resentment, especially by many of the regional advisers who are confronted every day with calls from their communities to protect their own needs.  But we are at crossroads that requires painful choices and to decide to follow one particular path could prove fatal"

Abbruzzese went on to say that the most appropriate strategy to deal with this phase of the restructuring plan, is to open a dialogue in the appropriate forum, and determine how best to implement the plan to ensure a brighter future. No one has in fact, assessed whether or not the implementation of the new plan will result in people being subjected to additional taxation.  People should not be exploited by politics, but this new experimental health care reform will be judged by the electorate in the upcoming elections.

When talking to those most effected there is general agreement amongst the populus of these rural towns, that health care should not be politicised. 

For many years the system has been in effect 'hoist with it's own patard.'  The funding of medical services by way of Government taxes has rewarded Italy with an ever growing elderly population.  The choice of families to have less or no children, arguably as a direct result of heavy taxation and life-style choices, means less people are available in the population to add to the Government pot.

From what we have learned, 1% of taxes are put towards health care provision.  For this the Italians recieve the most basic of care.  They are asked to subsidise the costs of tests,  X-rays (100 euros) and prescriptions (one standard charge for each medicine) for example.  But they expect more from their services, and they certainly don't relish the thought of driving 20 to 40 miles to receive hospital or specialist care.

"I am left with no hospital for my family and yet other towns will benefit from the services that I am expected to pay for.

Will they be riembursing me my 2 hour travel expenses and the loss of a days work to take my daughter to the next hospital which is in Rome! "

In conclusion so far, we give the last word to Jonas Kornai from his paper:

• The drawbacks are sensed immediately and individually by all concerned, in a way internalized into their own lives. It is harder to access accustomed treatment; doctors lose accustomed working conditions.
• They appear later as stronger, more financially disciplined, more efficiently managed, slower growth vs expenditure, with a smaller burden on the taxpayer.  All these benefit society as a whole, but they are not experienced as individual achievements. They appear as largely intangible external effects.
• Do we want to help today’s patients now or should we be thinking of the future too? If resources for health care are used badly, we ultimately rob future patients from resources by serving better treatment.
  

To repeatedly bailout and subsidise a service will only serve to encourage irresponsibility.  The reformation of health care services in Italy appears to be unavoidable and unstoppable.  Enzo and I have yet to find out whether public apathy, political promises or a combination of both has led to the imminent closure of these hospitals.

What is most concerning is the degree to which pressure will be applied to local general practioners who appear not to have adapted to these reforms as yet.  In the UK for example, general practitioners banded together in rural areas in order to share the work load and costs to provide a range of care.

My question for the mayors of Lazio seated in these rural areas is what happens next?