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Reportage. Even if the government keeps public health funding the same, Italy's ailing system will be underfunded by more than €20 billion.

12 million Italians skip health care because they can’t afford it

Starvation wages and miserable pensions, insecurity and poor jobs are pushing Italians to give up on health checks and treatments, or to go into debt, in order to have access to tests and sometimes vital surgeries. According to the Censis-Rbm Health Insurance report, presented Wednesday, in 2016, 12 million Italians forfeited or postponed at least one health service for economic reasons: 1.2 million more than in 2015.

There are 7.8 million citizens who have used their savings or have taken on debt from banks or relatives in order to have access to private health services with cannot be postponed. Nearly two million have dropped below the ​​poverty line.

Cuts and “rationalization” of health spending implemented over the past decade, coinciding with the austerity policies, have reduced public coverage and increased the use of private health care. This sector accounts for almost €35.2 billion with a record increase of 4.2 percent over the three-year period 2013-2016. According to the Court of Auditors, Italy has passed the European record in per capita reduction of health spending: 1.1 percent less per year, compared to GDP, from 2009 to 2015. In France, this expenditure rose by 0.8 percent a year and in Germany, by 2 percent.

The reduction of health spending that gave the coffers of many regions a breather, has been achieved at the expense of the citizens. The most affected are those in the South and, in general, those who have modest incomes. The private health expenditure falls most on those who have less, are less healthy and live in areas where health facilities are outdated or unreachable.

Only 20 percent of the population is able to protect themselves with a supplemental health insurance policy because it is provided for in their employment contract or a specific agreement with the employer. All others must pay. When they can afford it. This situation pushes those who need to resort to private health care. The waiting times for services have been stretched out of proportion, and patients would rather pay full price. For a mammogram, the wait time is on average 122 days, 60 more than in 2014; in the South, patients have to wait 142 days. The average wait for a colonoscopy is 93 days, six more than in 2014. For an MRI, the wait time is 80 days, 111 in the South. For a gynecological examination, patients must wait 47 days, eight more than in 2014.

The nine most difficult care orders to get are: specialist visits, prescriptions and payment for the co-pay tickets (contributions by the patient for some services, like emergency care, prescriptions, and specialist visits), diagnostic tests, dental care, corrective lenses, and rehabilitation services.

Added to this, there is the job insecurity of physicians. On Wednesday, Roberto Carlo Rossi, president of the Medical Association in Milan, wrote a letter to the Welfare adviser of the Lombardy Region, Giulio Gallera, denouncing a “plague” that infects “even the large facilities.”

“These colleagues face the prospect of being at a certain age without any social and economic stability, a condition potentially incompatible with the maintenance of a minimum professional and human decorum, Gallera says. He said precarious medical employment in Milan is under control and is lower than in other regions.

In 10 years, if public investments remain unchanged and in the absence of a public health policy, the situation will certainly be worse. The report makes a prediction: To ensure the maintenance of the current insufficient standards of care, the national health system will be underfunded by €20 billion to €30 billion. The solution proposed by the promoters of the report is the construction of a second health pillar, based on supplementary health insurance policies. They explain it like this: Since the public health system does not work, the universalism of care is a sham and the income crisis is devastating, the goal is not to refloat the system and make it fairer, but to privatize it with insurance instruments.

According to the 5 Star party, “An income subsidy, like the citizenship income [actually a minimum income] can help us get out of this situation.” To Fratoianni of Sinistra Italiana, “Politics must address the social emergency.” Adds Scotto of MDP: “Even with a decree to recover missing funds.”

But they are too late. Now it’s time for elections and election laws. We’ll see later. Maybe.

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