Italy

1. Italy Presented by: Christina Corson GRS 599-GA Siena Heights University

2. Map of Italy Located in southern Europe, it’s a peninsula extending into the central Mediterranean Sea, northeast of Tunisia including the islands of Sardinia and Sicily.

3. Information about Italy • Italy is a democratic republic (June 2, 1946). • Italy is centralized answering to a central government. • There are five regions that function with special autonomy statutes (Sardinia, Sicily, Trention-Alto Adige, Valle d A’osta, and Friuli Venezia Giulia). • 116,303 square miles make up Italy. Approximately the size of Georgia and Florida. • Founding member of the European Union (EU).

4. Demographics • Population: 61,016,804 (July 2011 C.I.A. est.) • Infant mortality per 1,000 live births: total: 3.38 deaths (C.I.A.) • Life expectancy at birth: 81.77 males (79.16) females (84.53) (C.I.A.)

5. The Economy of Italy • Italy has developed from an agriculture-based economy into an industrial-based economy. • Italy lacks in natural resources (iron, coal, or oil). They import most of their food. • Their economic resources come from processing and manufacturing of goods. • Italy’s major industries include machinery, motor vehicles, chemicals, pharmaceuticals, electronics, and fashion.

6. Education • Children are required to attend 7 years primary (100% attendance) school and 2 years secondary school (81.4%). • College: First level degree: 3 years Second level degree: 2 additional years • Adult literacy rate: Italy: 98%

7. Italy Ranks Number 2 • The World Health Organization assessed the world's health systems. • Found Italy was number two behind France (U.S.A. ranked 37). • WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs) (http://www.who.int/whr/2000/media_centre/press_release/en/).

8. Health of the Region Overall health of the nation is good. Italy scores near the European average. Significant access to health enhancing factors such as health services (99%), safe water (99%), sanitation (99%), with immunization levels (95%)(Fried, B.J., Gaydos, L.M. (2002). World health systems, challenges and perspectives,  Chicago, IL: Health Administration Press).

9. Leading Causes of Mortality • In Italy, non-communicable diseases such as cancers, cardiovascular diseases, COPD, and mental health disorders are the largest contributors to mortality. • Cancers are the leading cause of death among people under 65 years old. • Cardiovascular disease (CVD) is the leading cause of death among all the age groups. Accounting for 43.7 % of all deaths. • Male and females between the ages of 15 and 64: the male death rate is more than three times higher than the female rate for between 15 and 34 years of age and it is more than twice as high in people between the ages of 35 and 64 years old.

10. Other Causes of Death and Injury • The region has supported a steady drop in these kinds of deaths (accidents, accidental poisoning, violent acts and suicide). • Great Britain (3,297), France (4,709), Germany (5,091) and Italy (5,669). Italy at the top. • Male homicide rates are the second highest in Europe. • AIDS: AIDS cases are rising in Italy which is consistent with the rest of the northern and western European countries. Italy had a rate of 9.6 cases per 100,000 people. Majority of cases through sharing infected syringes. • Disability: 10.3% of the population suffered from disabilities that resulted in handicap, just below the EU countries averages of 11.5%. • Aging: Large and growing elderly population.

11. Organization and Management of the Health System Italian National Health System (INHS) Reforms

12. Italian National Health System (INHS) • Compulsory social insurance plan that provides comprehensive health insurance coverage and uniform benefits for all citizens and legal residents. • Started in 1978 with the belief that health services should be made available to everyone on the basis of need with no differentiation among citizens.

13. Three Different Government Management Levels • Ministry of Health: Responsible for planning, budgeting, and general administration. Including; monitoring, supporting, assessing and meeting health missions, and guiding implementation of prevention and care services throughout Italy. • Twenty Regional Health Authorities: Responsible for delivering services and ensuring the provision of healthcare to everyone in their jurisdictions. • Local Health Units (659): Responsible for the daily management and delivery of health services and for coordination between hospitals.

14. The Health Budget • Regulated centrally. Partially financed by employer and employee contributions with the government paying the balances directly. • Ambulatory and outpatient services are paid for on a diagnosis-related-group-type system. • Hospital services are free. • Citizens are responsible for a portion of the cost of dental care, pharmaceuticals (except essential drugs, they are free), and diagnostic exams. • INHS is financed through the National Health Fund which is determined as part of the government budget annually.

15. Finance • Majority of funding (64.6%) for the INHS is supplied from taxation; 31.2% came from copayments and direct payments. • The collection of funds for the INHS is the responsibility of the nation. • Each region receives funding on the basis of resident population. • Each region is accountable to the national tier for providing designated services. • Each region is responsible if they go over budget during the treatment of their population.

16. The Private Sector • The private sector makes up 20% of total health expenditures. • Citizens that seek care from private facilities must pay for private insurance as well as pay their INHS contributions. • Private service providers may also provide services within the public institutions. • The private sector provides services not covered by the INHS and helps relieve pressure when waiting lists are too long. • 16% of the population has private insurance and 16% of hospital beds are private.

17. Health Care Providers • Italy’s health system suffers a deficit of available providers with too many general practitioners (GPs) and a shortage of community nurses, social workers, and hospital nurses. • Medical school in Italy requires three years of post high school study for nurses, five years for dentists, six years for medicine. To specialize you would need to do an additional four years after your medical degree (except for general practice which requires only one year is required after medical degree is obtained).

18. Primary Healthcare • Includes diagnosis, treatment, and first level rehabilitation together with prevention, health promotion and education activities. • General Providers (GPs) usually provide this care (includes GP pediatrics, on-call services, pharmacies, and home care caregivers). • Specialist services include clinics and labs, family planning clinics, addiction and rehab services, mental health, and physical rehab centers. • GPs act as gatekeepers to specialty services. • GPs by law can only have 1,500-1,800 patients. • Patients are registered with individual physicians and not offices or practices. GPs usually have their own offices. • GP services are free at point of use. Waiting lists can be long so patients seek care at hospitals.

19. Secondary & Hospital Care • Hospital may be public or private. • Private hospitals may choose to contract directly with the INHS (accredited). • Public hospitals are directly managed by the ASLs and are financed thru the global health care budget. • Ministry of Health: general hospitals must provide general med., surgery, pediatrics, gynecology and obstetrics. • Care institutions contracted by ASLs is free with GP referral. • Patient choice is considered. • Each region has at least one hospital. • Pharmacies sell all drugs and are under numerous regulations.

20. The Future of Healthcare in Italy • Always room for improvement. • Main concern is keeping within the budget set by the national economic recovery plan (mandated that all programs must improve efficiency). • Another issue when planning for the future is the consequence of the aging population. Need for more services including long term care services which currently the region is lacking. • Possible resolution is requiring elderly to pay for some of these services.

21. References Fried, B.J., Gaydos, L.M. (2002). World health systems, challenges and perspectives, Chicago, IL: Health Administration Press. http://images.google.com/imgres?imgurl=http://www.perfectplaces.com/region_maps/italy/Italy.gif&imgrefurl=http://w ww.perfectplaces.com/Italy-Vacation- Rentals.htm&usg=__TRskw2ieiCqEfv3q5P9x00OvPo=&h=420&w=400&sz=42&hl=en&start=130&zoom=1&t bnid=qY_BFetxAneAnM:&tbnh=124&tbnw=118&ei=TTMkTuT9GYGQsAKx44iuAw&prev=/search%3Fq%3Dit aly%26hl%3Den%26biw%3D1366%26bih%3D585%26gbv%3D2%26tbm%3Disch&itbs=1&iact=hc&vpx=857 &vpy=202&dur=31&hovh=230&hovw=219&tx=114&ty=132&page=7&ndsp=22&ved=1t:429,r:12,s:130&bi w=1366&bih=585 http://www.nytimes.com/2007/08/12/opinion/12sun1.html?pagewanted=2 http://www.who.int/whr/2000/media_centre/press_release/en/ https://www.cia.gov/library/publications/the-world-factbook/geos/it.html http://italychronicles.com/zero-tollerance-in-italy/ ITALIAN HOSPITALS, MEDICAL CARE AND HEALTH ISSUES IN ITALY http://www.knowital.com/tourist/italy-health.html