Report. The Civic Report on Healthcare 2023 reveals a dire state of Italian healthcare, characterized by long waiting lists, overwhelmed emergency rooms, a shortage of primary care doctors, and the growing dependency on private healthcare.

Italy’s deadly waiting lists: three months for cancer surgery

Long waiting lists, overworked emergency rooms, a lack of primary care doctors in many areas classified as “healthcare deserts,” the need to spend for private healthcare, incompatible with a universalistic system – this is the picture of Italian healthcare that can be gleaned from the Civic Report on Healthcare 2023, published on Thursday by Cittadinanzattiva in an event that continued with a demonstration in front of the Health Ministry.

“The data and the stories people tell are leading us to proclaim a state of emergency and a permanent mobilization in defense of the National Health Service,” explained Anna Lisa Mandorino, secretary general of Cittadinanzattiva.

The protesters put forward five demands: the monitoring of the Essential Levels of Care and ensuring they are met throughout the territory; the elimination of waiting lists through investment in human and technical resources, planning and transparency, and concrete commitment on the part of the regions; the implementation of the right to digital healthcare; care and assistance paths for those with chronical diseases, rare diseases and diseases that make them non-self-sufficient by resuming the regulatory process for the recognition of caregivers; and the revamping of territorial healthcare.

Major complaints about waiting lists are found in nearly one in three (29.6 percent) of the citizen reports examined, but people are reporting shortcomings in all areas: hospitals (15.8 percent), territorial care (14.8), prevention (15.2 percent). It takes two years to get a screening mammogram, three months for a surgery for uterine cancer that should have been performed within a month, two months for an urgent gynecological examination which needs to be scheduled within 72 hours, again two months for a cardiological examination that needs to be done within 10 days: these are some examples reported by citizens, who also complain of dysfunctions in access and booking services, e.g., failure to comply with priority codes, difficulties in contacting the Single Appointment Center, blocked waiting lists.

In particular, for visits with the priority code Class B-short (which need to be done within 10 days), people have been waiting as long as 60 days for their first cardiology, endocrinology, oncology or pulmonology visit. Without a priority code, they have to wait 360 days for an endocrinology visit and 300 days for a cardiology visit. A gynecological visit with priority U (urgent, to be done within 72 hours) was scheduled after 60 days. For a cardiology, endocrinology or physiotherapy visit with priority B (to be scheduled within 10 days), citizens waited 60 days. For an orthopedic examination, again with class B priority, it took as long as 90 days. A uterine cancer surgery needed to be done within 30 days but the patient waited for 90 days. For a hip replacement surgery, due within 60 days, the patient had to wait 120 days.

Almost none of the regions have made up for the setbacks caused by Covid, and not all have used the €500 million fund set aside in 2022 for clearing the backlog of the waiting lists (about 33% of the money remains unused). Molise has invested only 1.7 percent of the funding available to it. Sardinia (26 percent), Sicily (28 percent), Calabria and Bolzano (29 percent) have also performed poorly. In 2022, there was a drop in patients undergoing specialist visits (from 42.3% in 2019 to 38.8% in 2022) and evaluations (from 35.7% to 32.0%). In the South, the latter figure dropped by 5 points.

Compared to 2019, the share of those who paid out of their own pocket for specialist visits (from 37 percent to 41.8 percent in 2022) and evaluations (from 23 percent to 27.6 percent) is on the increase. The use of insurance coverage is most common in Lazio (10.8 percent in 2022), Lombardy (9.7 percent), Bolzano (9.1 percent) and Piedmont (8.1 percent).

For emergency rooms, the most recurrent complaints by patients are about waiting for triage (18.9%), crowding (15.4%), poor patient information (9.8%), lack of inpatient beds (9.2%), staff shortage (8.7%), patients left in wheelchairs or on stretchers for hours/days (7.5%).

In the past 10 years, there has been a nationwide cut resulting in 61 fewer emergency departments, 103 fewer emergency centers, 10 fewer pediatric emergency centers and 35 fewer resuscitation centers. There are also 480 fewer type B ambulances (for non-emergency transport), 19 fewer pediatric ambulances and 85 fewer mobile resuscitation units. In Calabria, on average, an emergency response team arrives in 27 minutes, in Basilicata in 29 minutes and in Sardinia in 30 minutes, out of a national average of about 20 minutes. There are six regions that fall short of the Essential Level of Care for prevention: Sicily, Bolzano and Calabria are at the bottom of the results, and they have been joined since 2020 by Liguria, Abruzzo and Basilicata.

Regarding cancer screenings, invitations for organized screening campaigns dropped sharply in 2020: minus 29 percent for mammography screening, minus 24 percent for colorectal and cervical screening. The South shows the lowest adherence rates to these programs: in terms of mammography screenings, at the bottom of the rankings we find Calabria (9% adherence) and Campania (21%); in terms of cervical cancer screenings, Campania (13%) and Calabria (31%).

Ten thousand health workers participated in a survey on their motivations for staying in the NHS: according to over 46 percent of them, “they are satisfied with their career path but not with their work environment. More than 40 percent say they have unsustainable workloads, and one in three is unable to balance work and private life.” 31.6 percent reported being the victim of aggression (verbal or physical) from patients, 20.7 percent from their supervisor and 18.4 percent from colleagues.

Less than 3% of over-65s are included in Integrated Home Care pathways: 34% said the application phase was difficult, 21% considered the amount of care provided insufficient, 17% accused inadequate pain management. There are 2,227 family health counseling centers (1 for every 35,000 residents) compared to a minimum standard of 2,949. In 2008 there was one for every 28,000 residents, and in 1993 there was one for every 20,000. In Lombardy, Veneto, Friuli-Venezia-Giulia, Lazio, Molise, Campania and Trento, the average number is above 40,000 residents per counseling center.

Mental health is the subject of 27.8 percent of the reports, up sharply from the 2021 figure (12.8 percent), outlining a growing deficit in services. As a result, the management, if not outright the care of psychiatric patients is being delegated in a great many cases to the family. Regarding the provisions of the PNRR, which introduced Case di Comunità (Community Health Houses) for the provision of local healthcare, there will be many territories, especially inland areas, that will remain without such facilities: “the model of Ministerial Decree 77 fails to take into account territorial differences.” Meanwhile, from 2019 to 2021, the number of general practitioners in the system dropped by 2,178 and the number of pediatricians dropped by 386.

ANAAO Assomed together with citizens’ and patients’ associations, including Cittadinanzattiva, have launched an appeal in defense of the national health service: “The resilience of the system is now at risk. The right to healthcare is understood in 21 different ways, as a result of forms of regional autonomy that violate the constitutional principle of equality of citizens. The government’s differentiated autonomy project will accentuate the differences. The projected defunding in the coming years will force many citizens to pay for care out of their own pockets.”

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