<<  <  >  >>

Conditions in

centage of GDP on health care, expenditures

Inpatient care and primary care are free at

have been rising rapidly in recent years and

the point of treatment. However, copayments

Italy's public

have consistently exceeded government fore-

are required for diagnostic procedures, special-

hospitals are

ists, and prescription drugs.95 The size of such

casts.101 Between 1995 and 2003, total health

care spending rose by 68 percent.102 The Italian

considered

copayments has crept steadily upward over the

past decade and now runs as high as 30 percent

government has taken various steps to try to

substandard,

for some services.96 Several attempts have been

control costs, such as reducing reimbursement

particularly in

rates, increasing copayments, reducing capital

made to impose copayments for a broad range

expenditures, contracting with private provid-

of services, including primary care, but have

the south. They

collapsed in the face of public protests.97 In

ers, and limiting prescription drugs. All of

lack not just

these measures have met with protests, includ-

addition, nearly 40 percent of the population

modern

ing physician strikes, and many have been

(the elderly, pregnant women, and children)

are exempt from copayments.98

repealed after only a short time.103

technology, but

Italians have limited choice of physician.

The Italian government does not provide

basic goods and

They must register with a general practitioner

official information on waiting lists, but

services; and

within their LHA. They may choose any GP in

numerous studies have shown them to be

the LHA but may not go outside it. Except for

widespread and growing, particularly for diag-

overcrowding is

emergency care, a referral from a GP is required

nostic tests. For example, the average wait for

widespread.

for diagnostic services, hospitalization, and

a mammogram is 70 days; for endoscopy, 74

days; for a sonogram, 23 days.104 Undoubtedly,

treatment by a specialist. Despite these limits,

Italians enjoy more choice of physician than do

this is due in part to a shortage of modern

the British or Spanish.

medical technology. The United States has

Most physicians are reimbursed on a capi-

twice as many MRI units per million people

and 25 percent more CT scanners.105 Ironic-

tated basis (i.e., according to the number of

patients served over a given time period rather

ally, the best-equipped hospitals in northern

than the services actually provided), although

Italy have even longer waiting lists since they

some hospital physicians receive a monthly

draw patients from the poorer southern

regions as well.106

salary. Hospitals are generally reimbursed

according to DRGs, with rates set by the cen-

If delays become excessive, patients may

tral government--though regions sometimes

seek permission from the regional govern-

disregard those rates and set their own.

ment to obtain treatment from private doc-

Private health insurance is available in Italy

tors or hospitals at NHS expense. A recent

but is not widespread. Where offered, it is usu-

court decision allows patients whose life

ally provided by employers. About 10 percent

would be endangered by delays under the

of Italians have private health insurance, below

NHS to seek treatment in private hospitals

the percentage in most OECD countries.

even without prior permission from the

According to the insurance industry, this is

regional government.

partly because it is not possible to opt out of

Italy has imposed a relatively strict drug

the National Health System and because

formulary as well as price controls, and has

health insurance premiums are not tax

thereby succeeded in reducing pharmaceuti-

deductible.99 Private health insurance allows

cal spending, long considered a problem for

the Italian health care system. In 2006,

free choice of doctors, including specialists,

Italian drug prices fell (or were pushed) 5 per-

and treatment in private hospitals. Even with-

cent, even as drug prices rose in the United

out private insurance, however, many Italians

States and much of the rest of the world.

use private health resources (and presumably

However, the savings came at a cost: the

pay out of pocket). Estimates suggest that as

introduction of many of the newest and

much as 35 percent of the population uses at

least some private health services.100

most innovative drugs was blocked.107

Although Italy spends a relatively low per-

Conditions in public hospitals are consid-

13