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You need treatment? Cough up


In austerity Italy, the health system is increasingly privatised with four out of ten people now paying out of their own pockets to see a specialist.  Today, 3 billion euros worth of health services are provided to those who can afford it, reports Il Manifesto newspaper

“I am not going to get treatment because I have no money.” These days this kind of thing happens in Italy, where more and more Italians pay from their own pockets for health services that the public sector no longer guarantees.

According to a study by socio-economic research institute Rbm Health-CENSIS, presented this week in Rome, the most striking case is that of the dentist.

Between 2005 and 2012 private studies have seen the collapse of the number of treatments that come with a fee. This was dramatically highlighted a few months ago when from Palermo came the news that a 18 year old girl died due to an untreated abscess that caused a septic shock to her lungs.

A lack of prevention, and rejection of treatment, is increasingly common in Italy since the onset of the crisis that eroded incomes and increased mass unemployment. Almost a quarter of Italians are in this situation, according to consumer association Codacons, which points the finger at public health waiting lists that stretch for months.

Now 41% of citizens pay from their own pockets, and pay in full for specialist visits. For CENSIS, the sum spent on health charges, or the ‘ticket’ in 2013 amounted to close to 3 billion euro, a 10% increase in real terms over the period 2011-2013.

Need an eye examination in a public facility? Pay a 30 euro ticket and wait 74 days for the visit. If you are in a hurry, you can go to an private eye specialist. Then pay 98 euro and after seven days you get a prescription.

Complex treatment

And for the most complex emergencies, take cardiology visits. In public health you will pay a ticket of 40 euros, while the waiting list is 51 days. In private you pay €107 instead and wait for only a week. Fractured a foot? You need an orthopaedic appointment. If you turn to the public sector, you pay 31 euros and wait for almost a month. If instead you go private you pay 100 euros and wait just 5 days.

To perform a colonoscopy in a public facility the ticket costs 49 Euros and you can expect to wait an average 84 days. In private its 213 Euros for an 8 day wait. An MRI for your knee will cost you 49 Euros and its a 68 day wait, in private you cough up 149 Euros and wait just 5 days.

There seems to be no way out: in Italy, “private good because it works.” Provided, however, you can pay. If you don’t have the money, then steel yourself for a long journey that may have no end. Health is a matter of class.

Postcode lottery

In the public sector, waiting times are biblical, leaving you with a sense of impotence. The alternative is to go private. Or emigration. Not only from the [underfunded] South to the North, but also from the North-West to North-East, for example.

According to the Censis report there’s a real post code lottery: each region has a different rate. For specialist visits (ophthalmology, cardiology, orthopedic or gynecological) in the North-East you pay 20 euros, while in the South more than double: €45 on average. A mammogram costs a minimum of €36 in the Northeast. In the North-West a maximum of €48.

Public health has deteriorated. This is the view of 39% of Italians. In 2011,  29% took that view. And there’s been a fall from 57% in 2011 to 44% in 2014 in the proportion of those who judge the Italian regions competent in carrying out their responsibility for delivering health care. The common perception is that there is a direct relationship between the cuts imposed by budgetary rigor and austerity, and the decline in the quality of services.

The running down of the public health system in favour of private health care has also resulted in an exodus to Europe. Some 1.2 million Italians have crossed the Alps from treatment in the past seven years.

More cuts to come?

“Now only those who can afford it get treatment. Hospitals and community health services have been closed, while the so-called reform of the public administration that the Government of PM Matteo is planning, will continue the work of dismantling it – says Licia Pera of the USB union.  A further 10 billion euros of planned cuts is planned to health budgets, she says.

The CGIL argues that planned health reforms “must protect our health service, as an inalienable public service”  Stefano Cecconi, the head of health policy at the the union, says: “We must restore adequate funding after a period of indiscriminate cuts.” He adds that any savings identified from the government’s review of spending in the healthcare system “must be returned to the people with more services and fewer charges  for treatment. Abolishing the ticket altogether would be a true “‘exit strategy'” from the country’s healthcare crisis.

Translation by Revolting Europe


About revoltingeurope

Writer on Europe's Left, trade union and social movements @tomgilltweets or @revoltingeurope


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