The paper explores the delivery and acquisition of heath care in Italy. The general information concerning the system of hospitals, private and public clinics has been analyzed. It has been estimated that Italy can be characterized as a country with high-quality medical care. Public and private health care sectors are well developed and widely used by citizens of the country. Italian expenditures on the sector of health care are equal to 30 percent of the total spending. Furthermore, the data about private pay and health insurance have been discussed. It has been proved that health insurance in Italy is beneficial to the employed as well as to unemployed people. Moreover, the article describes the ways and methods of treatment of chronically ill people and those persons that are dying. According to the examinations, individuals with chronic diseases can be treated either at home or at hospitals and clinics. Despite the fact that the Italian government creates favorable conditions for ill people, chronic illnesses have a strong impact on the economics of Italy. The issues that deal with methods and ways of treatment in the state have been analyzed as well.
Keywords: health care sector, health insurance, chronically ill people, private clinic
Health Care System in Italy
The World Health Organization basing on a vast range of criteria has ranked the health care system of Italy as the second one after France among 191 countries. The following factors were included: the quality of services, health status, and responsiveness to expectations of its patients. A health care sector is usually financed by budgeted central and regional taxes. But at the same time each region is obliged to give additional services to people as long as the budget can provide this opportunity. There is a noticeable difference between the south of the country and its north part concerning health care services. The number of professional general practitioners, dentists, and physicians has constantly increased over the period of the last three decades. However, the health care system experiences the deficiency of nurses (Piai & Cattaneo, 2013).
General Overview of Health Care System in Italy
Hospitals, Private and Public Clinics
According to the Constitution of Italy, the central government and 20 regions carry an absolute responsibility for the conditions of heath care facilities. The national level of the country has to guarantee the basic objectives and principles. Furthermore, the Ministry of Health has to ensure healthcare planning, investments, governing, and monitoring. Regional governments bear the responsibility for ensuring the supply of a benefit package. They as well have to do this kind of service with help of local health establishments as well as private and public hospitals (Piai & Cattaneo, 2013). The institutions of the local government include ASLs, or in other words, local health enterprises. These establishments carry the responsibility for the assessment of health needs and ensuring the care for a geographically defined general public. The peculiarity of ASLs is that these organizations provide a direct care either through own facilities or with help of private providers with accreditation. The list of private providers includes: nursing homes, various laboratories, and long-term as well as acute hospitals. In Italy, there is a special kind of hospitals that is called Aziende Ospedaliere. These are public establishments that possess a relatively high level of independence. In addition, these institutions provide a highly professional secondary care (Piai & Cattaneo, 2013).
Nowadays, there are more than 660 public hospitals, which are eager to provide both: patient and inpatient services. In addition, in Italy, the number of private hospitals is equal to 553. These ones include, in general, non -profit institutions. Furthermore, since 1994, a vast numbers of specialized hospitals have been provided with a so-called privilege of technical and financial autonomy.
These establishments have the status of independent hospitals. In the year of 2000, the amount of hospitals decreased. At that period of time, Italy was one of the countries with the lowest number of hospital admissions. But after the 2000s this statistic has been on its constant increase (Scalzo et al., 2009).
In Italy, the patients have an opportunity to choose a place where they wish to be treated. They can opt among hospitals, private and public clinics. It is rather interesting to notice that in Italy there are many licensed pharmacies. They may be of two types: private and public. As a result, hospitals dominate in the Italian health system. Doctors are, as a rule, generally salaried employees. The Ministry of Health is responsible for quality assurance. It is obligatory for doctors to be certified. The sector of private hospitals must achieve the accreditation in order to sign a contract with SSN (Scalzo et al., 2009).
Private Pay and Health Care Insurance
Despite the well-developed public health care sector, nowadays many Italians choose the private sphere more and more often.
They believe that the quality of private sector is much higher. Speaking about the pay, it is rather important to stress that a patient in Italy pays privately around 20 percent of the healthcare spending (Negri, Taupitz, Salkic, & Zwick, 2014). Taking into consideration the results of the socio-economic research institute in this country, it is possible to make a conclusion that Italians do not trust their life to the public sector of healthcare. Furthermore, according to the recent statistics, more than 40 percent of people in Italy have claimed that the sector of public health care services provides only basic services. For that reason, patients resort to private areas. They are eager to pay huge sums of money for complex services. However, the prices for private sector healthcare products are decreasing (Negri, Taupitz, Salkic, & Zwick, 2014).
Italian expenditures on the sector of health care are equal to 30 percent of the total spending. It means Italy receives a high level of out-of-pocket payments. On the contrary, on the basis of the recent statistics, it has been estimated that ten percent of patients there have private health insurance. Furthermore, the number of people who wish to have such insurance is constantly increasing.
There are many reasons why private insurances are beneficial. One of the main causes is that insurances in the private sector are optimizing personal businesses by the way of sending customers to cheapest providers of the health care supply (Davies & Higginson, 2004).
Insurance usually provides benefits to both: employed and unemployed. If a person is legally working in Italy, an employer is obliged to pay insurance. To get the insurance from the employer the patient has to accomplish the following steps. First of all, the employee has to go to the local health establishment and register with the health convention. In case the employee registers, he or she will get two important things: the health number and the health card. As a result, the employee will get a prescription from a doctor (Davies & Higginson, 2004).
Heath Care towards Chronically Ill People
Ways of Treatment of People When Dying
The health care sector creates favorable conditions to chronically ill people. It means that these people are not ignored in any case.
The health care sector in Italy is based on the principle that every member of the Italian society has the right to be secured or hospitalized in case of serious sickness, disability, due to an old age or even the lack of livelihood (Davies & Higginson, 2004).
According to this principle, all people have the right to receive the medical care of a high quality. The state has to take care for people who have serious or even incurable diseases. It has a close ties with the palliative care. The latter one was from the very beginning created for people who had cancer. But nowadays the meaning of this word has expanded. A wide range of studies have proved that around sixty percent of chronically ill people wish to be treated at home. In spite of this fact and, at the same time, despite a strong will of chronically ill patients to be cared at home, the treatment of these people in hospital is a common strategy in many countries, including Italy (Davies & Higginson, 2004).
Moreover, patients with chronic illnesses mainly receive care at home. However, this method of treatment has a vast range of disadvantages. It enables a better and deeper understanding of consequences and results of social support. Many scientists support an idea that social support influences the chronically ill person in a far better way. The experts in the field of heath care provide explanations why treatment at home is more widespread than the care of chronically ill people in hospitals (Petrinco et al., 2006). The first and main reason is that the number of chronically ill people is constantly growing. Secondly, the hospitals in many countries, including Italy, are characterized with the deficiency of available impatient services. Besides, very often, people with physical disabilities wish to stay at home and be treated by personal caregivers. One more important reason for this is the lack of equipment and experts in the sphere of inpatient services. Some doctors assure that social support influences chronically ill people in a negative way because social support decreases mortality. In case of dying, a person is given an opportunity to choose where to spend the last days of the life: at home, at hospice or in the hospital. There are many reasons why people choose to be at home.
They are the same as for chronically ill people (Petrinco et al., 2006).
It has been estimated that chronic illnesses have a strong influence on the economics of Italy. It has a direct connection with expenditures for health care. It is stated that the data concerning costs for chronically ill people are not available. However, there are different studies about costs for chronic diseases. For instance, the International Health Care Organization for Diabetics has calculated the spending of Italian health care sector for people with diabetes. Due to the results of the study, diabetes expenses constitute nine percent of total expenditures. According to the other study, COPD patients in Italy cost in general 2. 723 euros. It should be noted that 2.507 euros are connected with healthcare direct costs (Piai & Cattaneo, 2013).
As a result, the government of Italy does not have to provide the service of hospitalization to all chronically ill people. For these reasons, in 2007, the Ministry of Health in Italy issued a program concerning home care and treatment of people with chronic illnesses. Their governmental document includes the following steps and procedures. It provides the patient free choice of care.
Therefore, it creates a special indicator for quality performance and focuses on the issue of care-giving at home. It has many advantages for the state. The document stimulates the awareness campaigns of citizens (Piai & Cattaneo, 2013).
Who Chooses the Methods of Treatment: a Patient or a Doctor
The question if a patient has an opportunity to decide how to be treated is rather topical as well. In Italy, the Code of Medical Ethics states that physicians have a free will expressed by an individual to get a medical treatment. In case the patient refuses to follow this kind of treatment, the task of a physician is to desist from treatment or diagnosis. Moreover, the physician cannot ignore the wish of a person that wants to be treated (Negri, Taupitz, Salkic, & Zwick, 2013).
Having analyzed the general information concerning the system of hospitals, private and public clinics, it is possible to make the following conclusion. The health care service sector in Italy is one of the most well-developed and effective ones in the world. The government of the country takes care about all its citizens. It has been estimated that public and private sectors are well developed. However, many inhabitants of the country support an idea that private health care sector provides a vast scope of qualitative services. On the contrary, the public system is eager to ensure only basic health care services. The quality of health service sector in this country is constantly increasing. The employees in Italy are willing to get the health insurance as it can be characterized by positive consequences and results. Furthermore, the government of the state pays attention to the ways and methods of treatment of chronically ill people and those ones that are dying. It has been estimated that persons with disabilities can be treated in hospitals or receive health care services at home with the help of caregivers. Nowadays, physicians in Italy do not face serious constraints in the budget. However, even today there is some underinvestment in the sphere of health care in Italy.
The vast range of reforms and funding will improve the health care sector in this country.