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Health Care Systems in Italy and America: A Gordian Knot combining Public and Private.

Updated: Jun 21, 2023

The below blog post was first published in Italian for Fortune Italia by Dr. Antonio Giordano

Health Care Systems in Italy and America: A Gordian Knot combining Public and Private.

As seen by the Obama Reform of 2010, the American Health System is increasingly adopting the European model, focusing on universal access to services, especially for the less privileged, who lack insurance coverage.

On the other hand, the Old Continent's healthcare systems are moving away from the "solidarity model" and the general population and, as a result, more or less intentionally, guiltily of ending up transferring services and managing the successful operation of healthcare to private firms.

Choices are influenced by unsustainable waiting lists for both appointments and surgical procedures in the field of oncology.

Delays, which can be fatal for patients, are caused by management failures and bureaucratic delays that result from incompatible organizational plans at the levels of government and single health organizations (hospitals and local health companies), where politics heavily influences the appointment of general managers and the decisions they make.

It is also necessary to condemn the migration of citizens to private structures, which is occasionally supported by administrators or academic entities.

It is difficult to pinpoint who to blame for this change, but the simple deals made with the NHS and the ineffectiveness of the public sector open the ideal scenario for this "creeping privatization" of our health service.

Here in Italy, as in the USA, the Gordian knot of the health system and biomedical research itself: how to allow a healthy coexistence of two health systems that base their existence on two antithetical ideas such as the universal right to health vs profit?

The first big step taken by the United States towards a more equitable and inclusive system of care, less linked to the economic status of citizens and representing a paradigm shift in the entire US health system, was undoubtedly the Affordable Care Act of 2010, now revived and completed by President Joe Biden.

The Obama-promoted reform has dramatically altered a model that is still largely private, far from being a model of public health, while simultaneously increasing access to the middle class and broadening the pool of beneficiaries of health programs run on a federal level to families with lower incomes and to people over 65.

Increased periodic screening and preventive programs for the most common and dangerous diseases have put patient safety and prevention in a vulnerable economic situation at the forefront of the conversation.

The Italian Health Service implements Article 32 of the Italian Constitution, establishing the right to health care for all individuals. A universal system, typical of Welfare States, guarantees state-funded health care through general taxation and direct income through health tickets, quotas that citizens contribute to expenses, and paid services.

The application of these constitutional principles is still strongly challenged by the complicated reality linked to the management gap of health facilities between Northern and Southern Italy.

Although some centers of excellence (it's hard to say whether they are the majority), despite various administrative challenges and flaws, still manage to stand out in the depressing national landscape, the difficulty of raising funds to invest in strengthening public health and research (the latter still completely neglected in the list of political objectives in the short and medium term) and the dispersion of human resources have a detrimental effect on our Health System.

Young doctors and researchers are leaving the country in massive numbers to work abroad, and patients are moving to private hospitals frequently deemed "better" because they can sell a better perception rather than provide better services.

Instead, the ideal goal would be to pursue a system that integrates two comparable systems for high-quality healthcare.

However, the public must continue to prioritize its social and educational goals, and the private sector must provide a viable alternative for individuals who want to benefit from the same public offer in a different context or pursue non-essential services that the public has decided not to provide.

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