Italy's Public Health System Needs a Paradigm Shift

To save Italy's public healthcare system, it undoubtedly will be essential to bring the system's funding, as a proportion of gross domestic product, in line with the average of countries in the Organization for Economic Co-operation and Development. This step will not be enough, however, if the system's management approach is not changed. According to the latest joint report from an Italian association of healthcare professionals and private research institute CENSIS, the healthcare system is threatened not only by insufficient resources but also by the profit-oriented approach that prioritizes budget constraints over the necessity and appropriateness of health services for patients.

The National Federation of the Orders of Surgeons and Dentists (FNOMCeO) wanted to present the report in Rome as part of an event called "From Economics to the Primacy of the Individual." In a statement, the FNOMCeO added, "The widespread experiences of Italians with very long waiting lists for access to healthcare services in public or accredited private facilities, and the inevitable resort to private services to shorten access times, as well as experiences in crowded facilities with services below the expected quality standards, have given the need for a different approach to healthcare dramatic social urgency."

The increase in demand, which is mainly related to the aging population, augments the financial burden on the system. This factor, together with the prioritization of budgets over patient needs, results in an increase in out-of-pocket expenses for families. This situation compromises one of the fundamental principles of the Italian healthcare system: that necessary services are guaranteed to everyone, regardless of their means. 

Decreasing Salaries 

Forty years after the introduction of ​​a managerial approach to health services, most Italians are concerned about the direction that the system has taken. In the past 24 months, 44.5% of Italians surveyed for the FNOMCeO-CENSIS report directly or through family members experienced overcrowding in hospital wards or healthcare facilities. This percentage fell below 40% in the northeast but reached 46.8% in the south and the islands.

It is a vicious circle: Inadequate supply of services exasperates citizens, who engage in legal disputes and aggression toward healthcare workers. The latter in turn work under constant stress, experience burnout, and receive significantly lower salaries than colleagues in other countries.

In the public sector, for example, doctors' salaries have decreased by 6.1% in real terms from 2015 to 2022. So can we blame the 180,000 professionals (131,000 doctors and approximately 48,000 nurses) who have emigrated from 2000 to 2022? Or those who, even while remaining in Italy, work across the border in Switzerland or France? Increasing weekend shifts or raising the retirement age to 72 years for doctors and 70 years for nurses, even on a voluntary basis, will not resolve this situation.

These circumstances make employment in public administration unattractive for healthcare professionals. These workers have completed a long and challenging course of study and endure working hours, shifts, and precariousness that do not align well with personal and family needs, to say nothing of the elementary demands of health.

Unattractive Specialties

Between 2012 and 2022, hospitals' use of nontenured and temporary doctors increased by 75.4%. Public spending on care by nontenured doctors, temporary doctors, and other health and social services in the private sector amounted to €3.6 billion in 2022. This figure represented an increase of 66.4% over that of 2012. 

Moreover, it is precisely the poor quality and the poor economic and social recognition of work in public health facilities that make specialized schools unattractive. But without such education, it is harder to find work in the private sector or in emergency medicine, pathology, virology and microbiology, and radiotherapy. 

If many of the positions in these fields are not filled each year, then efforts should be made to make them more attractive, for example by increasing the salaries for those who choose the most difficult specialties to integrate into private practice. Franco Locatelli, president of the Superior Health Council, put forward this proposal in a meeting organized by the Witness Association of Parre in Clusone.

The CENSIS research brings out clear priorities: increasing doctors' salaries to align them with those of comparable European countries, investing more public resources in facilities' capacity to provide services, and above all giving doctors autonomy on decisions about the appropriateness of services. Budgetary constraints currently limit this autonomy.

These reforms will be essential if they are accompanied by a campaign of modernization. There must also be an appeal to professionals' and citizens' sense of responsibility, so that they do not fall into the trap of defensive medicine and health consumerism. These behaviors contribute to uncontrolled spending on unnecessary or inappropriate services, which are already estimated to represent more than 20% of the total in Italy. Let's not forget that inappropriate services sometimes harm patients instead of helping them. 

This story was translated from Univadis Italy, which is part of the Medscape professional network, using several tools, including AI, as part of the process. Human editors reviewed this content before publication.