For a general article on health in Italy, see health in Italy Healthcare spending in Italy accounted for 9.2% of GDP in 2012, slightly lower than the average of 9.3% in OECD countries. About 77% of the spending is public. In 2000, Italy's healthcare system was regarded, by World Health Organization's ranking, as the 2nd best in the world after France, and according to the World Health Organization, Italy has the world's 6th highest life expectancy. The life expectancy at birth in Italy was 82.3 years in 2012, which is over two years above the OECD average.
History
After World War II, Italy established its social security system including a social health insurance administered by sickness funds and private insurances. In the 1970s the social health insurance faced severe equity problems as coverage differed between the sickness funds, around 7% of the population remained uninsured, especially in the South. Moreover, sickness funds went practically bankrupt by the mid-1970s. Due to growing public dissatisfaction with the existing healthcare system, Italian policymakers led by the Center-right party Christian-Democrats, instituted structural reform. In 1978, the government established the SSN — or National Health Service — including universal coverage for all population financed through tax funding, while private health continued to exist but was reserved for those who were willing to pay for extra services or services not offered by the NHS, such as dentistry or psychology
The National Health Service was created in 1978. Healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service, Servizio Sanitario Nazionale, which is organized under the Ministry of Health and is administered on a regional basis. Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subjected to availability. Prescription drugs can be acquired only if prescribed by a doctor. If prescribed by the family doctor, they are generally subsidized, requiring only a copay that depends on the medicine type and on the patient income. Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be sold in specialized shops. In a sample of 13 developed countries, Italy was sixth in its population weighted usage of medication in 14 classes in 2009 and fifth in 2013. The drugs studied were selected on the basis that the conditions treated had a high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross-border comparison of medication use. Visits by specialist doctors or diagnostic tests are provided by the public hospitals or by private ones with contracts to provide services through the national health service, and if prescribed by the family doctor require only a copay and are free for the poor. Waiting times are usually up to a few months in the big public facilities and up to a few weeks in the small private facilities with contracts to provide services through the national health service, though the referring doctor can shorten the waiting times of the more urgent cases by prioritising them.
Performance
Surgeries and hospitalization provided by public hospitals or by conventioned private ones are completely free of charge for everyone, regardless of their income. For planned surgery waiting times can be up to many months, especially in the big cities. The Italian National Outcomes Programme permits measurement of variation in the quality and outcomes of care by region, which is very considerable. So, for example, the proportion of patients receiving coronary angioplasty within 48 hours of a heart attack varies from about 15% in some regions, such as Marche, Molise and Basilicata to nearly 50% in the northern regions Valle d’Aosta and Liguria. Measured at Local Health Authority level the levels varied between 5% and more than 60%. This geographic variability was the greatest of any of the 11 countries studied by the OECD. There is evidence of patient movement, generally from south to north, probably driven, at least in part, by a search for better quality.
