Report
Italy’s two healthcare systems: the South has worse care and more deaths
Those living in the southern regions today have a life expectancy 1.3 years lower than in the center and northwest and 1.5 years lower than in the northeast, according to a new report.
When it comes to health care, Italy is divided in two because of a poorly and thoughtlessly funded health system. And the authors of the report Un Paese due cure. I divari Nord-Sud nel diritto alla salute (“One Country, Two Kinds of Care. North-South gaps in the right to health”), presented last week in Rome by the Association for the Development of Industry in Southern Italy (SVIMEZ) together with the Save the Children NGO, predict that differentiated autonomy will further increase inequality.
In recent years, the main health indicators have improved (slightly) throughout Italy. But since progress is slower in the southern regions, the gap is only getting wider. For example, those living in the southern regions today have a life expectancy 1.3 years lower than in the center and northwest and 1.5 years lower than in the northeast.
The same goes for avoidable mortality, i.e. deaths that could have been prevented through timely and effective care, which is significantly higher in the South (18 avoidable deaths per 10,000 inhabitants, compared with 14-16 in the rest of the country).
In recent years, a historic switch has also taken place: until 2010, the highest cancer mortality rates were in the northwestern regions, characterized by greater pollution and a less healthy lifestyle. In a little more than a decade, the situation has reversed: now the cancer mortality of women and men in the South is the highest in the country.
Less prevention also has something to do with it: only 12 percent of Calabrian women undergo periodic mammograms offered by the National Health System, compared with 75 percent of women in Emilia-Romagna. “Strengthening the universal scope of the National Health System is the way to make the constitutional right to health an effective reality,” says Luca Bianchi, director of SVIMEZ and the author of the report.
However, the trend is going in the opposite direction, starting with investment in public health and its distribution among regions. Overall, public spending on health is lower than in other similar countries.
According to SVIMEZ, Italy is the only major European economy in which per capita public investment in health care between 2010 and 2019 declined in real terms “by more than 2 percent,” while in France and Germany it increased by more than 30 percent. Even the post-pandemic upswing (+5%) was less than those in Germany, France, the United Kingdom, Spain, and Portugal, all of which were in the double digits.
As a result, it is up to citizens to make up for the shortfalls of the public health service out of their own pockets. Private out-of-pocket spending by Italian households accounts for 24 percent of total healthcare spending, compared with 15 percent in France and 13 percent in Germany. Given that foregoing care for economic reasons is a reality for 8.2 percent of southern households compared to 4-6 percent in the rest of the country, it is a natural corollary that healthcare is worse in the South, where five out of eight regions are unable to guarantee the Essential Levels of Care.
The system for allocating the national-level health funds to the regions also seems to be tailor-made to increase inequality, the report explains. Funds are allocated according to the number of total residents, newborns and the elderly.
Socioeconomic conditions – which, according to a growing and extensive body of literature, influence the health needs of the population – count for very little (1.5 percent) in the allocation. Giving equal shares to unequals ends up penalizing the South, poorer and in greater need of care.
“The condition of family poverty strongly affects prevention pathways and children’s access to care,” says Raffaela Milano of Save the Children. “An effort from the institutions at every level is needed to ensure a network of prevention and care services for children and adolescents that would be able to respond to the needs, with targeted investment in the most deprived areas.”
The arrival of differentiated autonomy is likely to make territorial differences even sharper. The greater tax revenues retained by the richest regions would strengthen their health spending capacity at the expense of the others. According to the SVIMEZ experts, this would lead to “a risk of increasing financial inequality between regional health systems and the widening of interregional inequalities in the conditions of access to the right to health.”
Originally published at https://ilmanifesto.it/la-sanita-e-gia-differenziata-al-sud-meno-cure-e-piu-morti on 2024-02-08