Italian Healthcare System
Italy is one of the most attractive European countries in terms of the level of economic development and living conditions. It also has rich cultural and historic heritage and wonderful nature, which make it outstanding among the other countries. The country is also characterized by a strong family spirit and devotion to a healthy lifestyle. The current research reveals the system of healthcare in Italy, providing its basic features and describing the main issues. Modern Italian healthcare is financed mainly by the state, and essential healthcare services are free for citizens and residents. The private share of healthcare providers is very low, and they mainly account for additional services such as laboratory tests and dentistry. The main issues of Italian healthcare are the imbalanced system of regional funding and a low level of community and home care coverage. Finding solutions to these problems is the focus of the Italian government. The issues are being partially resolved by creating complex entities that provide all kinds of services for people in need.
Nowadays, Italy is one of the highly developed European countries, the sixth one in terms of population, the seventh according to its GDP, and the eighth based on the quality of life index. It consists of 20 regions of various sizes, populations, and economic development, each possessing unique history, and cultural tradition. Since ancient times, Italy has been the center of knowledge and culture with a huge number of historic monuments, buildings, galleries, and museums. Another curious fact is that Italy is a country of many contrasts. Having ancient and rich cultural history, Italy is one of the politically youngest countries. The cherished traditions and cultural heritage are strongly intertwined with the high level of civilization and quality of life. In general, the development of the healthcare sector is considered the top priority at the socio-cultural and governmental levels of the country as it directly affects the well-being of the population. Since its establishment as a unified country in 1861, Italy has been developing fast. The focus of the development of the country was its economy and provision of a high level of well-being for the population. Basic demographic and health indicators show that the life of the general population has improved greatly over the recent decades and the average life expectancy has increased. However, the population growth rate is relatively low, immigration being the main source of it. The healthcare system in Italy is considered one of the most efficient in terms of population coverage and service delivery. Each region has a network of health units and healthcare centers linked to a regional hospital. The majority of healthcare establishments are public, which closely cooperate with a relatively low share of private ones. The population mainly suffers from circulatory and respiratory diseases as well as tumors. The major health challenges are smoking and obesity, in young people in particular. This paper will discuss the general social and healthcare features of Italy and the different aspects of the life of Italian immigrants in the USA.
Italy is characterized by the usual social stratification for the industrial society. The difference in wealth can be tracked from north to south; the gap between the rich and the poor is noticeable, and the unemployment rate is quite high, especially due to immigrants coming from poorer countries. The network of social welfare is struggling to support everyone in need; however, the budget for this purpose has been cut recently to fit the EU requirements.
The main social boundary markers in the country are speech, manners, style of clothing, food choice, and recreation possibilities. Clothes from fashion designers, prestigious food, and entertainment are beyond the reach of many Italians. Despite this fact, everyone has access to healthcare services for satisfying the basic needs of the population.
Customs, Traditions, Cultural Values and Family
In the Italian culture, values such as love, friendship, respect, and family are the core principles. It is typical for Italians to enjoy life in its various manifestations; and they prefer to bring this principle into everything they do, from work and business to leisure and hobbies. Another typical cultural value of Italians is paying close attention to appearance, physical shape, and clothing.
The major Italian customs and traditions are centered on the appreciation of family. They are also strongly attached to the place of their living. Each small town has its history, some specialties they take pride in. Be it local food, a castle, a mountainous view, or the proximity of the sea, this feature is promoted and appreciated. The time spent with the family is cherished and highly appreciated. The elderly people are treated with great respect, and children are considered as the most precious value in life. The strongest tradition is to eat together. Many people come home for lunchtime with the family. Similarly, dinner lasts long for enjoying meals and sharing the events of the day with the closest people. The Mediterranean diet is considered very healthy and promotes longevity, which is another feature of Italian people. They prefer pastry for breakfast, hearty balanced meals for lunch, and have a very light dinner, which usually involves a glass of wine. Italians buy much fresh and organic food to cook and eat the same day. Vegetables, bread, meat, and fish are bought at local farmers’ markets; the other food can be purchased in a supermarket. A large number of Italians like to grow vegetables. They usually grow greens, herbs, and tomatoes on a balcony or a patio; however, it still brings them considerable pleasure. Italians like to cook at home. Most traditional Italian food is easy to cook, and the recipes are passed from generation to generation. They also like to take a walk in the evening after dinner, breathe fresh air and spend some time with the family. Italians also do sports as they are very concerned about appearance; they try to keep fit and eat only healthy food (Zimmermann, 2017). Such a lifestyle with a slow pace of life, healthy eating, and balanced activity involves a low level of stress.
Language, Arts & Literature, Expressive Styles
Italian is the official language of the country. It belongs to the Romance language family and originated from Vulgar Latin. Apart from the standard official variant of Italian, there are a vast number of dialects that are spoken in different regions across the country. The development of the modern variant of the language has started in the thirteenth century the vocabulary and language structures of regional spoken dialects enriched the Latin language. The Florence dialect had a major impact; it ultimately evolved into the standard language as it was used by the originators of the Italian literary tradition, Dante and Petrarch. Thus, many universal arts, music, and literary terms in various world languages are Italian in origin.
Italy has an ancient cultural heritage, which is obvious throughout the country. Archeological remains of Greek and Roman culture are found across the country, and Rome is a city museum. Throughout the country, there are numerous museums, churches, and galleries containing millions of art pieces from the past, and libraries holding over 100 million books. Italian art has always been strongly supported by benefactors, and this tradition continues in the present.
Italian literature originated from Roman and Greek writing traditions. Until the thirteenth century, poems, chronicles, and legends were written in Latin. The first works written in Italian were courtly poems modeled from Provencal verses by Sicilian poets. Many great figures such as Dante, Petrarch, Boccaccio continued the Italian literary tradition, bringing mysterious motives, fiery passion, and the adventurous spirit of true-to-life stories to literature. Italian literature underwent a decline and renaissance; it is full of sophistication and simplicity, reflecting the historical reality, feelings, and desires of people and their strong and passionate spirit. Starting from the middle of the twentieth century, Italian literature flourished again. A variety of styles emerged in the country, and all the major literary movements of the West were reflected in the works of Italian writers.
Italians are a very artistic and creative nation. This potential is expressed in various ways, particularly through music, performance, and literature. Italians are naturally very expressive in their voice tone, body language, facial expressions, and gestures. This peculiarity makes them marvelous actors and singers highly acknowledged across the world. Nowadays, with the development of technology, new expression styles of visual arts such as photography and video appear in the country.
Italy is a Christian country. 88% of the population is Roman Catholics. Many world religions have representation in Italy too. They are Muslims, Eastern Orthodox Christians, Protestants, Evangelists, Jehovah’s Witnesses, and Baptists. Only some extreme sects are prohibited in the country.
The prevalence of Roman Catholic Christians in Italy is defined by their unique religious heritage. The Catholic Church has always had considerable influence on the government and social life of the country. Close relations between the church and the state continue until today, whereas the spiritual tradition remains at the center of Italian society and politics. Every town has at least one Catholic church, and religious festivals are important for the majority of people. Italians also prefer to be married, baptize children and observe all Christian holidays. Rome is also the place where the Vatican is located, a small sovereign state which is the center of the Roman Catholic Church and the home of the Pope.
Forms of Government
The Italian state emerged from the Sardinia-Piedmont Kingdom. In 1848, King Charles Albert adopted a constitution, which became the basis for the modern set of laws. It introduced a bicameral parliament and the cabinet of ministers that is chosen by the king. With time, ministers assumed considerable power and responsibilities. After World War II, a referendum was conducted, which showed the desire of Italians to replace the monarchy with a republic, and thus a new constitution was adopted. This constitution cannot be amended easily, which hinders the imposition of the dictatorial regime. The basic principles introduced in the document include the proclamation of Italy as a democratic republic, sovereign to the people, inviolable rights and personal freedoms of people, equality of all people before the law, the obligation of the state to fight social and economic factors limiting any freedoms of the people. A separate article states the protection of linguistic minorities. Additionally, the constitution secures the rights of all religions before the law; however, a special status is granted to the Roman Catholic Church.
The Constitutional Court has four basic functions. First of all, it acts within the state and regional law. Secondly, it resolves conflicts between administrative offices at different levels. Finally, the Court servers as the court of indictment and has the power to grant permissions for holding referenda on different topics.
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The Parliament is bicameral; it consists of the Chamber of Deputies and the Senate. The Chamber of Deputies or the lower house is elected through the system of proportional representation. The members of the Senate or the higher chamber are selected similarly. However, several positions are granted by the President and are occupied for life. Senators and deputies serve their duty for a five years term, enjoy immunity from search, arrest, and criminal trials, and have a salary defined by law.
The President of the republic is the head of the state and serves the term for seven years. The President is elected by a college consisting of the members of both chambers of the Parliament and can be impeached for high treason or offense against the law. The President has special power and responsibilities; his laws and decrees have the force of law. Additionally, he can call special sessions of the Parliament, ratify treaties and declare war. The President also has the right to dissolve the Parliament either upon their request or if requested by the Government.
The Government consists of various ministers that are responsible for definite departments and controlled by the head of the Council of Ministers. The latter is responsible for directing governmental policies and controlling administrative activity. The President functions as a mediator between the Government parties. The Government issues administrative regulations, which have to be presented and approved by the Parliament, and only after a parliamentary approval, they can be put into force by the presidential decree (“Italy,” n.d.).
Italian economy consists mainly of the service sector, industry, minor agriculture, and small to medium-sized businesses. After the economic crunch, the country’s economy has shown some improvement in terms of GDP growth due to the increased level of household consumption and income. Good trade conditions and increased domestic demand fostered some growth of export and import rates and helped to maintain the stability of the Italian economy on the European and world markets. Another important sector of the Italian economy is tourism due to the wonderful nature and rich historical heritage of the country. More and more tourists come to visit Italy every year, spending large sums of money and contributing to the total value of export, which suggests further growth and development of this sector. Recent data shows that tourism accounts for 11.8% of the national GDP, while industry provides around 25% and agriculture about 3% (Farnesia, 2017).
The national healthcare services sector is funded by national and regional taxes. Besides, some additional funds come from pharmaceuticals and outpatient care. The total spending on healthcare accounts for around 9.2% of GDP, while the average expenditure in the EU is 9.6%. In general, 78.2% of the total spending on healthcare was public. The rest 20.8% of healthcare services were funded by the private sector, mainly diagnostic procedures, pharmaceuticals, and non-urgent interventions. Only 1% of healthcare services was funded by private health insurance.
Additionally, a difference in funding for different regions can be observed throughout the country, ranging from 10.2% to 17.7% per capita. The funding is done at the national level and distributed to regions; however, it varies depending on the tax rates. Unequal funding results in uneven cost distribution. Hence, poorer regions receive less, while the needs for medical care are usually higher there than in high-income regions. In recent years, some attempts were made to place strict control over regional healthcare spending to exclude the situations of severe deficit. At the same time, the price for outpatient care, laboratory tests, and medicaments increased to drive more money from the private sector (Ferr? et al., 2014). Healthcare services in Italy are provided mainly by public centers and some private entities. All doctors are allowed to combine public and private practice. Such practice is possible within National Health Service, which facilities pay rent from their income. The payments for hospital and outpatient care are set in correspondence to national rates determined by the Ministry.
The healthcare system in Italy is controlled by the Ministry of Health, which sets the primary goals and principles for healthcare, defines the core package of guaranteed health services, and provides funding across the regions of the country. The delivery and organization of these services are the responsibility of the regions. At the regional level, local healthcare authorities facilitate the provision of public, community, and primary care through public hospitals or private clinics.
The National Health Service covers all healthcare expenses for the citizens and legal foreign residents. Since 1998, even undocumented immigrants have had access to basic and urgent healthcare services. Tourists and visitors can receive the required medical help by paying for the cost of treatment. The majority of services are financed by the state; however, regions can launch some additional funds with further integration into the healthcare sector. As far as the National Health Service does not provide an opportunity to choose the type of the medical system and use private care only, there is no need for substitutive insurance.
The use of private health insurance is quite limited in Italy, accounting for only about 1% of the total healthcare spending. The majority of services covered by this type of insurance are some extra options securing a higher standard of privacy and comfort for in-patient hospital care and a wider choice of healthcare providers. Private health insurance is available in two forms: corporate, where companies cover healthcare expenses for employees and in some cases their families, and noncorporate, with individuals buying some extra services for themselves and their relatives. The insurance policies can be received from voluntary mutual insurance organizations as well as corporate and collective funds established by some professional organizations for their members. The majority of insurance policies are acquired by individuals, and only 26% are purchased by groups (Donatini, 2016).
The delivery of the basic primary medical services is free. These services are categorized according to the criteria such as medical urgency, appropriateness, and efficiency. Pharmaceuticals, hospital care, preventive medicine, and home care comprise a positive list of services offered to residents. The negative list consists of services that are not available for patients, are covered on a case-by-case basis, such as orthodontics and laser eyesight correction, and services for which hospital admission is not required. Regional healthcare providers can provide such kinds of services to the public; however, they have to be funded privately. The essential level of care provided by the regional healthcare centers does not include mental illnesses, preventive measures, and long-term care services. The framework for such cases as well as the scope of diagnostic, curative, and rehabilitative services are defined by national authorities. Preventive services, including immunization and early diagnostic, are also covered at the national level.
The pharmaceuticals available for the patients fall into three tiers depending on their clinical effectiveness and cost. The first-tier drugs are covered in all cases. Medicines from the second tier are covered only in the case of inpatient care. The third-tier drugs are not covered at all. For instance, dental care is generally not covered and is to be paid for; however, it is included in the essential level of medical care for specific categories of the population such as children under 16, disabled people and people with rare diseases, low-income people and the cases of urgent need.
There also exists a system of cost-sharing. Various procedures and visits to specialists can be prescribed by a general practitioner or by a specialist and since neither consultation nor hospital stay is paid, patients are charged a copayment for each prescription. However, private or public providers cannot charge any additional fees as per an official agreement with the National Health Service.
The Delivery of Healthcare Services
The primary care can be received from physicians, general practitioners, and pediatricians, who sign a contract and pay the rate for each patient in their list. The patient list payments comprise about 70% of overall income; the rest comes from payment for specific treatment including surgeries, care of chronically ill and elderly patients. General practitioners sign an agreement every three years, and this agreement contains all the details on payments duties and responsibilities. Additionally, they can sign a separate contract for the delivery of some additional services. The patients have to register with a doctor whose list has not reached the maximum limit of people, and they can change their physician any time.
In recent times, doctors prefer to group practice over working solo. The legislation provides a couple of ways to organize group medical practice. The base group practice is when general practitioners working in different offices share their expertise, work together on establishing guidelines, and conduct workshops and training sessions together. The network group practice allows sharing the electronic health record system. The advanced group practice means that doctors share the office, the electronic record database and can deliver services beyond their catchment areas. In addition, doctors working in group practices receive higher rates per patient. Similarly, it increases if a doctor hires a nurse or an assistant. The aim of promoting group practices lies in the idea that a healthcare entity can satisfy all the possible healthcare needs of the population in the complex. Thus, hiring additional medical personnel and social workers will drive more revenue to the office.
Outpatient care is usually provided by a local healthcare unit or by any contracted public or private hospital. Patients can choose the hospital; however, they cannot select a specific specialist, who is assigned randomly. Generally, self-employed doctors and nurses provide outpatient care and charge an hourly fee for their service. Such specialists can have as many patient visits as they can manage to fit into their schedule, while those physicians and nurses who work for hospitals cannot.
Hospitals are either semi-private or controlled by a local healthcare unit. They receive payment for all the kinds of services they provide, including diagnostics and consultations of physicians. Besides, hospitals with the status of teaching get some additional funds. Thus, about 10% of their revenue comes from covering the training costs. There are numerous variants of payment systems depending on whether the costs have to be cut in case the spending limit is reached. They also exclude some services and tools from the basic pattern of patient care. Doctors who work at hospitals receive salaries and are not allowed to treat patients in private clinics; otherwise, they have to pay some rate from their additional income to the hospital (Jurijus, 2014).
There is also a range of services for providing long-term care and social support to patients. Individuals who require this type of care are generally treated in residential or semi-residential facilities or receive care at home. Residential and semi-residential units of healthcare provide the services of nurses, doctors, and rehabilitologists along with needed medical therapies and devices. The cost-sharing for these services depends on the level of income of the patient. For instance, home care is financed publicly and is designed for providing some additional assistance during the treatment. The level of funding of this sector is quite low in Italy. By contrast, palliative care is delivered mainly by voluntary organizations. Additionally, the national policy also contributed to the emergence of such services as hospices, daycare units, and palliative care departments in hospitals. Nevertheless, much has to be done for further development of this sector as it does not provide the necessary coverage at the moment.
The Main Strategies to Raise the Quality of Healthcare
The monitoring of the quality of healthcare services is performed by the local and national governments. All the contracted doctors have to be certified and undergo compulsory further training. Besides, any additional education of doctors and the staff is encouraged. Hospitals are also accredited according to the criteria outlined by the National Commission for Accreditation and Quality of Care. Hospitals' accreditation varies across the system in combination of three main components: the quality of infrastructure and the level of human resources, the appropriateness and timely manner of the process, and the outcome of treatment resulting in the health status and satisfaction of the patients. Apart from that, all healthcare providers are required to keep a performance chart with indicators of quality, waiting for time, and statistics on the patients’ outcomes and complaints. In general, these data are issued in written form on leaflets and the hospital’s website (Organisation for Economic Co-operation and Development, 2015).
One of the most urgent concerns in the healthcare sector of the country is interregional inequity. Thus, some regions simply lack the number of beds, while others may have a developed network of private units but lack some advanced equipment. As a result, community care is scarce, which can be tracked from the north to the south of the country. Finding a solution to this situation is the main focus of the modern National Health Plan. The issue can be solved by redirecting costs for health services to regions that require additional funding based on the demographic characteristics and the level of use of healthcare services (Toth, 2014).
On the other hand, the interrelation and integration of healthcare units and social care services have improved greatly, which resulted in bigger coverage of community care patients and delivery of outpatient care. Besides, programs for handling chronic patients have been developed and implemented on the regional level.
The biggest wave of Italian immigrating to the USA happened at the beginning of the XIX century. The people who came to the country were unskilled workers mainly engaged in the industrial sector. About a half of those who came to America returned to Italy eventually, and the modern Italian-American community originated from those who decided to stay and brought their families to the US to begin a new life. The process of assimilation was tough as Italians were associated with the mafia and faced numerous negative stereotypes. However, this prejudice became less distinct with time. Currently, strong family values and a rich cultural background make the Italian diaspora noticeable among the greatly diversified American population.
The healthcare system in the USA differs from the Italian one. Firstly, the countries differ in terms of the cost of healthcare, which is the main barrier faced by the immigrant population. In the USA, the cost of a definite procedure would depend on the type of insurance and can be very high in some cases. Other issues are the language barrier and cultural beliefs. Even though trust in modern medicine has become higher, a large percentage of the immigrant population prefers to use traditional and folk medicine instead of visiting a doctor. The main health conditions requiring treatment are cardiac diseases, high cholesterol levels, and obesity (“Italian Americans,” 2010). In general, the immigrant population has access to all the required medical services. However, patients are not able to receive the required help due to the high cost of care and the lack of information and thus prefer to go to Italy, where they can receive all the treatment free of charge.
In general, Italy is a well-developed European country with a rich history, religious and cultural heritage, which has influenced the current status of the country. The deep tradition of appreciation of the family reflects a strong national spirit of the Italian people. Italians also prefer to have a slow and healthy lifestyle, eat a healthy diet, enjoy the fresh air, and moderate sport activity. These factors promote the strong health and longevity of the majority of the population of the country. Besides, Italy has a strong level of economic development compared to the rest of the EU members. The main contributors to the GDP of the country are industry, tourism, and agriculture. These sectors also provide the majority of working places. The system of healthcare in Italy is highly developed too. It is regulated at the national level and executed at the regional level. Medical services are provided mainly by public units and a small share of private institutions. The essential medical care is free of charge for the citizens and residents of the country, whereas additional services require payment. The weakest point of Italian healthcare is the disbalance in the system of regional findings. Thus, the bigger part of the budget is allocated to regions that provide higher taxes, while the needs for medical care are higher in poorer regions. Another problem is the low level of community and home care system development as it does not provide the necessary level of coverage.