Country Profile

Italy

The National Health System in Italy

by Laura Dai Pra

 

General Information

Health care in Italy is provided by the National Health System, a government-funded institution that provides medical care, as well as socio-psychological intervention to the entire population. For a generally small co-payment, anyone can receive diagnostic procedures and treatment in the context of well-defined settings, such as through the family doctor, the local health units, and the hospital. Primary and secondary prevention and rehabilitation services are accessed through the same channels.

Even with this comprehensive, inexpensive health delivery system, the quality of public health services is often prone to cumbersome bureaucracy, long waiting lists for certain procedures and, in some situations, poor interpersonal interaction between the health provider and the patient. This causes many people who can afford the high fees to seek medical care from privately-operated doctors' offices and hospitals.

 

The National Health Plan

The necessity for overall improvement of the quality of public health has received a great deal of political attention over the last few years. In 1994, the National Health Plan stressed the importance of citizen participation in health care planning. Citizens can now play more active roles in evaluating the efficiency of the system and the quality of the services provided, such as the availability of health promotion interventions. In the past few years, hospitals have been required to activate Public Relation Services that collect the patients' evaluations of the treatment and assistance received, along with comments and suggestions on how to improve the quality of the service. It is important to point out that the 1994 National Health Plan explicitly introduced health promotion in the repertoire of intervention strategies. This years' plan extends the scope of health promotion strategies by defining a few broad principles:

  • Promotion of healthy lifestyles;
  • Fight against the major causes of death (cardiovascular diseases, cancer, infectious diseases, accidents);
  • Improvement of the environment; and
  • Protection of "weaker" members of the society (children, elderly, disabled, destitute, etc.).

 

A set of specific goals have been defined, including a reduction in:

  • prevalence of obesity (25% in men and 30% in women);
  • number of smokers (from 34% to 20% of men and from 16% to 10% of women);
  • alcohol abuse (30%);
  • mortality rates of cardiovascular diseases (10%), cancer (10% in men, 5% in women), traffic and worksite accidents (20%);
  • infections contracted in the hospital;

 

and increases in:

  • number of organ transplants performed;
  • number of mandatory vaccinations for immigrants.

 

Settings and targets of health promotion interventions

Interventions that enhance well-being are not only provided by a wide range of professionals and researchers within the health care arena, but also within ducational institutions, the worksite, and the urban environment. These programs are all offered in a framework that promotes satisfaction, better communication skills, healthy environments, and general well-being.

It is known that promotion of well-being is best accomplished by implementing programs in a variety of settings, based on population demographics and the goals of specific interventions. The school and the workplace are among the main targets in Italy. A wide range of health promotion interventions are available from primary grades through high school, including health, nutrition, and sex education, as well as programs aimed at the improvement of traffic safety and environment protection. AIDS prevention was officially introduced in school in 1990, with programs that involve both the students and their parents. The workplace has also been gaining importance as a target for preventive interventions. A recent milestone is a 1995 law that brought Italy up to speed with European regulations of risk assessment and safety at work. Public and private companies alike are required to apply these guidelines in order to provide risk control interventions.

In the context of European policies, a 1989 parliamentary law declared that health education be part of school programs involving both students and teachers. The main objective is to promote the well-being of the individual at three ifferent levels: with oneself, or psycho-physical equilibrium, within the social or cultural environment, and with the government and the European community.

Finally, recent studies and interventions have addressed issues related to the quality of life in the neighborhood. They are generally aimed at the improvement of the relationships between the citizen and social structures, such as school, the local health unit, and local government, in order to create better living nvironments.

Laura Dai Pra is a health psychologist, currently working at the Sleep Disorders Laboratory at Georgetown University in Washington, D.C. She can be reached there via e-mail at gb@codon.nih.gov. She will be returning to her native country, Italy, as a health promoter in the future.

 
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