Difference between revisions of "Healthcare and social assistance in the Kingdom of Italy"

Revision as of 07:32, 9 July 2018

Healthcare and social assistance spending in the Kingdom of Italy accounted for 15.2% of GDP in 2015. In 2000 Italy's healthcare system was regarded, by World Health Organization's ranking, as the 2nd best in the world after France.

Ideological assumptions

The concept of social assistance is distinct from the notion of charity by distinguishing the final purpose, of collective or individual advantage, to which the performance tends. The social assistance, unlike charity, is based on the advantage given to the national community and on the biological principle of the conservation and defence of the race, aimed not only to its physical recovery but also to the moral one. The fascist Constitution establishes the "right to health" of all Italians under a double character: on one hand the right to health is also a duty to be in an healthy physical condition; on the other hand as part of the duty of the State of providing and protecting biological and moral quality of the Italian race; the indivdual advantage provided by healthcare is, by an ideological point of view, a by-product.

The Fascist State therefore organizes the health system as a public system of a "universalistic" character, typical of a social state, which guarantees health care to all Italians, funded by the State, by Corporations and by direct revenues, received through health tickets, with paid services.

While collective and racial health is pursued by the Ministry of Health and Social Assistance, the individual-aimed (and proviately-provided) charity is regulated by the Ministry of Interior.

National Health Service

Healthcare is provided to all citizens and residents by a mostly public system, founded through a corporatist financement. The public part is the National Health Service (Italian:Servizio Sanitario Nazionale, S.S.N.), which is organized under the Ministry of Health and of Social Assistance.

General Practitioners and family doctors are entirely paid by the S.S.N., must offer visiting time at least five days a week and have a limit of 1,500 patients. Patients can choose and change their GP, subjected to availability.

Prescription drugs can be acquired only if prescribed by a doctor. If prescribed by the family doctor, they are generally subsidized, requiring only a limited copay that depends on the medicine type and on the patient income (all the prescribed drugs are free for the poor). Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be sold in specialized shops (farmacia).

Visits by specialist doctors or diagnostic tests are provided by the public hospitals, and if prescribed by the family doctor require only a limited copay and are free for the poor.

The National Health Service is a national level body that organizes regional services on a regional basis.

The National Health Service is articulated according to different levels of responsibility and governance: the State has the responsibility to ensure all citizens the right to health through a strong system of guarantees and through the concrete implementation of the expenditure for the achievement of health objectives of the country.

Organization

The National Health Service is therefore not a single administration, but a set of bodies and bodies that contribute to achieving the objectives of protecting the health of citizens. In fact, it consists of:

• Ministry of Health and Social Assistance, which directs the national health plan;
• Higher Health Council (Consiglio Superiore di Sanità, C.S.S.);
• Higher Institute of Health (Istituto Superiore di Sanità, I.S.S.);
• National Agency for Maternity and Children (Opera Nazionale Maternità e Infanzia, O.N.M.I.);
• Italian Medicines Institute (Istituto Italiano del Farmaco, I.I.Fa.);
• Scientific Hospitalization and Treatment Institutes (Istituti di Ricovero e Cura a Carattere Scientifico, I.R.C.C.S.)
• Experimental zooprophylactic institutes;
• Local Hospitals and Local Social and Health Units, through which the National Health Service provides health care.

Local Social-Health Unit

The Local Social-Health Unit (Unità Locale Socio-Sanitaria, U.L.S.S.) is the public body responsible for providing localized healthcare services. The U.L.S.S. performs the tasks of the National Health Service in a given area, usually corresponding to the Mandment. The U.L.S.S. are part of the National Health Service, are public bodies with legal personality, with organizational, managerial, technical, administrative, patrimonial and accounting autonomy. Personnel working in the U.L.S.S. prevention departments carry out administrative police activities and, if delegated by judicial authorities, judicial police.

Organs and organization

They are organs of the U.L.S.S.:

• the general director;
• the Consultative Council, which brings together the heads of subdivisions and related agencies (including local bodies of separate agencies subject to the overall direction and coordination, such as the National Agency for Maternity and Children).

Each U.L.S.S. is organized in the following structures:

• Hospital Presidium;
• Hospital District;
• Health District;
• Local branches of separate agencies;
• Divisions.

Hospitals may or may not be autonomous from the U.L.S.S.

Divisions

The divisional organization is the ordinary model of operational management of all activities. The Head of Division is appointed by the Director General of the U.L.S.S. among the heads of complex structures aggregated in the Division itself. The Head of Division is a member by right of the Consultative Council, and is assisted by a Divisional Advisory Committee.
The Division's management (which may be hospital, territorial or preventive) involves both professional responsibilities and managerial responsibilities.

Personnel

The staff of the U.L.S.S. is recruited through public competition announced and managed by the Ministry of Health and Public Assistance. The personnel is subdivided in roles:

• Health role;
• Professional role;
• Technical role;
• Administrative role.

Hospitals

A Local Hospital is a public hospital facility, part of the National Health Service, which performs the function of a hospital, and is also used for specialist services where requisites and conditions are met. If the Hospital is dependent on a Local Social-Health Unit, it takes the name of "Hospital Presidium" (Presidio Ospedaliero).

Hospital Presidium

The "Hospital Presidium" is a hospital not established in an independent body; therefore it has much less autonomy, in spite of it having autonomy at managerial level (presence of a responsible physician and an administrative manager) and functional with separate accounting, even if it is internal to the budget of the relevant ULSS. The medical director of the Hospital Presidium depends on the general director of the relevant ULSS.

Local Hospitals

The Local Hospitals assure health specialization activities with advanced and innovative diagnostic and therapeutic technologies and perform the tasks specifically assigned by the national planning acts and documents. All Hospitals are equipped with an emergency and acceptance department. Ordinarily, Local Hospitals depend on the relevant ULSS, but some categories depend directly on the central organs.
Each Hospital has an Administrative Director, a Medical Director and a Medical Commission. The highest manager is the Director General, appointed by the Minister of Health and Social Assistance.

Classification

Local Hospitals are divided into three classes, depending on the catchment area:

• Class 1 Hospital: with a catchment basin of between 80,000 and 150,000 inhabitants, with first aid and an essential number of specialties;
• Class 2 Hospital: with a catchment basin between 150,001 and 300,000 inhabitants, with emergency-urgency departments and various specialties and advanced technologies: for example, an emergency room, a medicine department, a surgery department and twelve specialized departments;
• Hospital of Classe 3: with a catchment basin between 300,001 and 1,000,000 inhabitants. They are predominantly large hospitals not spun off from the ULSS and having special specializations, for example with the addition of neurosurgery and cardiac surgery.
• High Specialization Hospital: they are public health bodies with public juridical personality, organizational, administrative, patrimonial, accounting, managerial and technical autonomy. High Specialization Hospital must have at least three highly specialized structures and a functionally grouped and unitary divisional organization. They depend on the Regional Division or on the Ministry itself.
• Polyclinic: university hospitals, or "polyclinics" (Policlinici), are established by decree of the Rector of the relevant University upon authorization of the Minister of National Education and of the Minister of Health and Social Assistance, with the function of both public assistance and university education, and are provided of ìstrategic and management autonomy.
• Scientific Hospitalization and Treatment Institutes: special hospitals, public or private, that carry out clinical research activities, as well as the management of excellent healthcare services.

Emergency medicine

The emergency medical services in Italy currently consist of a combination of volunteers and public organizations providing ambulance service, supplemented by physicians and nurses who perform all Advanced Life Support procedures. The emergency telephone number for emergency medical service in Italy is 118. Emergency medical service is always free of charge. First aid is provided by all the public hospitals: for urgent cases it is completely free of charge for everyone (even for the undocumented), while a copay (about £35,000) is sometimes asked for non-urgent cases.

See also

• Welfare state in the Kingdom of Italy