Italy | Is public health in Italy collapsing? Rich people skip the line – El Salto

Article 32 of the Italian Constitution reads, “The Republic protects health as a fundamental right of the individual and an interest of the community, and guarantees free assistance to the poor.” However, the reality is very different.

In Italy you have to wait several months, sometimes even more than a year, to see a specialist or to have a diagnostic test. The lines at emergency services are getting longer and longer. Many towns and neighborhoods lack “family doctors” and you have to travel several kilometers, while hospitals and health centers are closed. The Italian public health system is working increasingly worse, as evidenced by the latest report on “Fair and Sustainable Wellbeing” by the Italian National Institute of Statistics, ISTAT. Despite the chaos experienced during the Covid 19 pandemic, the number of places available in hospitals in Italy continues to decrease due to cuts decided by various governments, including that of Giorgia Meloni.

Where there were 258,000 beds in 2020, there will only be 225,500 in 2022. Independent studies estimate that Italian hospitals lack at least a million general hospital beds and twelve thousand intensive care beds. Italy ranks 22nd in the European classification of the number of beds, with an average of 314 per million inhabitants for general hospitalization (the European average is 550) and nine per million inhabitants for intensive care (Germany has 30, France 20). The number of hospitals is also declining: almost 100 have closed in 10 years, 9% of the total. There were 1,091 in 2012, only 996 in 2022.

12 of the 20 regions do not even guarantee the minimum level of assistance required, that is, the assistance considered essential. The Naples region is one of the most affected areas: in 2002 there were 55 public hospitals in Campania, in 2022 there are only 46. At the same time, accredited private clinics have gone from 61 to 73.

Doctors and nurses have to work in ever-worsening conditions, with salaries that are among the lowest in Europe and with unstable rhythms and workloads. Over the past five years, the number of violent attacks against healthcare workers has increased by 30%, and complaints of “medical errors” have also multiplied.

Between 2019 and 2022, up to 11,000 health workers will leave public health. The result is that the average age of Italian doctors is increasing rapidly: 56% are over 55 years old

Partly due to the “closed number system”, which limits students’ access to health faculties, the number of doctors and nurses is becoming increasingly insufficient. Many of those who specialise go abroad in search of better conditions and higher salaries. Between 2019 and 2022, up to 11,000 health workers leave the public health service. The result is that the average age of Italian doctors is increasing rapidly: for example, 56% are over 55 years old, compared to 14% in Great Britain. In 2025, 29,000 doctors and 21,000 nurses will retire, creating a gap.

All recent governments (centre-left, centre and right) have cut public health expenditure, which this year represents 6.4% of GDP. It will fall to 6.3% in 2025-2026 and 6.2% in 2027. The collapse of public healthcare forces a large number of citizens to resort to private healthcare, which paradoxically is increasingly financed by the state and the regions.
In 2022, the contribution of citizens – who already pay taxes to support the National Health Service – reaches 41 billion euros (24% of total health expenditure).

The more public hospitals fall into crisis – when they do not close – the more private clinics and outpatient clinics proliferate, giving rise to a lobby that is politically powerful and able to influence the national and local political class, both legally and illegally.

In addition, for over a year now, the phenomenon of so-called “personal emergencies” has cropped up.
Each year, the country’s public emergencies record a total of 20 million admissions, which are becoming increasingly crowded and understaffed. The result is that patients have to wait an average of eight hours for mild cases and three hours for severe ones.

According to the study, 70% of people going to emergency services could and should be treated by regional outpatient clinics or home care services, which however do not exist or function poorly.

The result is that more and more people with means decide to skip the line and go to private centres. At least for less serious medical emergencies, which are known as “white codes” and “green codes”. “This is the so-called practice Cherry pickingBy which private healthcare chooses the most convenient and profitable services, leaving public healthcare with “disposable” services in which the value to be protected is not profit but health, the Basic Union denounces.

If the emergency is serious, you have to go to public emergencies, because private ones prefer to secure funds but without taking on too many responsibilities. “Until recently, emergencies were not a matter for the private sector, which was clearly interested in maximizing profits in routine diagnostic activities, leaving the deficit socialized and burdening the public budget,” says the Federation of Veterinarians and Doctors (FVM) of Piedmont.

“It makes no sense to call them emergencies, rather they are clinics where simple services are performed. For example, I cut my finger on a can of tuna and went there,” explains Fabio De Eco, president of the Italian Society of Emergency Medicine. In these clinics, in some cases open 24 hours a day, you can be seen by a professional without having to wait in line. It is enough to pay 150 euros. However, all the tests and visits to the specialist are at the expense of the patient, who can go home with a bill of hundreds or thousands of euros.

These structures were born in the Milan area, which has been governed uninterruptedly by the right since 1994. Here, half of health services are already provided by private healthcare subsidized by the national health system. It is in Mila that the empire of the San Donato Group was born and developed, which manages the San Raffaele hospital, the subject of several investigations in recent years.

Lombardy is also the region where the first major outbreak of COVID-19 occurred in 2020 (when the authorities refused to close the Val Brembana so as not to punish the companies and factories concentrated in that area) and where the highest number of deaths were registered in relation to the population, especially in nursing homes and hospitals.

Whenever new private emergencies open, protests and controversies erupt, as happened in Turin. “After closing the public ones, we are now thinking of opening recognized private emergencies. We disagree. It would be useful to have more beds to be able to admit patients and thus avoid them waiting for several days on a stretcher,” writes the ANAIO doctor association, for example.

In a statement, the BASIC trade union also denounced “a health system that is increasingly being geared towards the rich”, following the opening of other “private emergencies” in Lombardy, which the workers’ organisation described as “a health store similar to shopping centres”.

“Fewer and fewer young people are entering the health professions; it is estimated that Italy has a shortage of around 150,000 male and female nurses.”

“The deteriorating working conditions and the freeze on salaries, especially during Covid, have pushed many people towards private healthcare, where, however, working conditions are no better and, above all, there is a lack of control. But, in general, fewer and fewer young people are entering the health professions; it is estimated that Italy has a shortage of around 150,000 male and female nurses,” Michela Flores, head of the “private healthcare” sector of the BASE trade union union in Rome, explains to El Salto Diario.

“In private healthcare, in general, the number of workers affiliated with unions is lower than in the public sector and, in any case, unions that are allied with companies prevail,” explains the unionist. “Most of the private sector is represented by accredited private hospitals, where citizens access by paying a co-payment – as in public hospitals – and the rest of the cost is covered by regional health systems. Of course, these centers encourage patients to stay in the private circuit to get maximum benefits.”

“If it is true that Lombardy has set the line, private healthcare is now expanding rapidly in other regions. In 2026, 54% of beds in the Rome region will be guaranteed by the accredited private sector,” reports Flores. “Accredited private emergencies were few, but they had existed for some years, especially in areas where there were no public emergencies. There was a public route, which was similar to what the general emergencies offered, but the patient could choose a private channel and pay for specialists, for example. Suddenly, Lombardy allowed the opening of completely private ’emergency rooms’, where you pay for everything.

Those who cannot afford it are forced to stand in line and, when they are able to be examined, are sometimes sent home by tired and stressed doctors on duty, who are unable to diagnose serious pathologies in a matter of minutes or even hours. Hospitalisation lasts several days or even results in the death of the patient. Because of endless waiting lists and rising costs, around 4.5 million Italians are now abandoning medical care. The lack of timely and adequate treatment – not to mention the lack of prevention – thus causes an increase in the number of victims.

When a hospital closes, communities, associations and unions unite and protest, but the political class continues to believe that public health care is a cost that must be reduced, while public funding for private health care increases.