Italian National Health System
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The Italian NHS
Jan. 30, 2017, by Daniele Tari, M. D.
The Italian National Health System (NHS or SSN in Italian language abbreviation) is a public system of universal nature that guarantees health care to all citizens, funded through general taxation (taxes), direct insertion (sanitary ticket) and chargeable services.
According tothe Article 32 of Italian Constitution, which enshrines the "right to health" of all individuals, the NHS provides:
- Primary care: all those services to which the citizen accessed directly on the territory (General Practitioner GP, Pediatrician PLS, Medical Guard);
- Secondary and Tertiary care: all those services to which the citizen accessed through the general practitioner (examination by medical specialists, diagnostic tests, etc.).
It is not a single administration but a set of national and regional entities and institutions and it is organized according to different levels of responsibility and government:
- The central level: the state has the responsibility to ensure all citizens the right to health through a strong system of guarantees based on the Essential Levels of Care (LEA);
- Regional level: regions have direct responsibility for the implementation of the government and the expenditure for achieving the health goals of the country via General Hospitals (Azienda Ospedaliera AO, Aziende Ospedaliere Universitarie AOU or Polclinico) and Local Health Authorities (ASL or AUSL) whichorganize and provide health care in their territory trough public or private accredited health facilities.
Founded in 1978 (Law n. 833 of December 23rd ), active from 1st July 1980, the Italian NHS becamein 2000 the second best healthcare system in the world in terms of cost efficiency and access to public care for citizens, after France (WHO research). In 2014, according to a ranking compiled by Bloomberg it appeared third in the world for efficiency of spending.
Official Web Site of Italian NHS (only in Italian):
Local Health Authorities
Each region indicates a particular name for these institutions.
- Abruzzo, Campania, Lazio, Liguria, Piedmont, Puglia and Sardinia: Local Health Authority (ASL).
- Valle d'Aosta: Azienda - Unità Sanitaria Locale della Valle d'Aosta (AUSL VDA)
- Lombardia: Agenzia di Tutela della Salute (ATS),
- Trentino: Azienda Provinciale per i Servizi Sanitari (APSS),
- Alto Adige: Azienda Sanitaria dell'Alto Adige (ASDAA),
- Veneto: Azienda -Unità Locale Socio Sanitaria (AULSS),
- Friuli-Venezia Giulia: Azienda per l'assistenza sanitaria (ASS),
- Emilia-Romagna, Toscana e Umbria: Azienda - Unità Sanitaria Locale (AUSL),
- Marche: Azienda Sanitaria Unica Regionale (ASUR),
- Molise: Azienda Sanitaria Regionale del Molise (ASREM),
- Basilicata, Calabria e Sicilia: Azienda Sanitaria Provinciale (ASP),
- Sardegna: Azienda per la Tutela della Salute (ATS).
List of regular services offered for free:
Free delivery of health products for certain categories of persons (diapers for incontinent, syringes for those who have diabetes, gluten-free foods for celiac disease), prosthetic or medical devices (crutches, catheters, special mattresses). For these products the citizens must have an application, filled out by the GP or specialist, and authorized by local health authorities: with this request they may withdraw the products in pharmacies;
- Rehabilitation services;
- House assistance;
- Access to retirement homes and nursing homes (RSA);
- Psychological and psychiatric care (through the Mental Health Departments);
- Assistance to the terminally ill;
- Obstetric, gynecological and sexual education (through family planning clinics, consultori);
- Drug addiction rehabilitation (SERT);
- Hygiene Service (vaccinations);
- Forensic assistance;
- Prevention of infectious diseases of animals (through the veterinary service).
Access to some of these services is direct (e. g. Family counseling, hygiene service), in other cases it is necessary the intervention of the general practitioner (e. g. Home care, access to the RSA).
The LHA also offers services of social, specialistic and collective health care, an administrative department and a veterinary medicine. Each LHA provides its services through the Health District or "social health district" that is the territorial institution deputy of the provision of primary care through physicians (general practitioners and specialists) and pediatricians(PLS) and of the local management of requests for specialist services and diagnostics, as well as applications for hospital services in outpatient and inpatient settings.
The system of primary care at this level includes services and
performance for primary and specialist care, family planning clinics, home
and semi-residential care. The district thus plays a key role to widen or
narrow the range of services and to integrate the needs of different players
involved in health promotion, prevention of disease and disability, social
and health services.
The Social and Health Districts provide:
- Family doctor and pediatrician;
- Access to tests and specialist services in outpatient clinics, polyclinics and hospitals;
- Health emergency: medical guard, emergency (118) and Emergency Room (A&E, Pronto Soccorso);
- Prevention: vaccinations, information and screening;
- Protection health: environment, food, work, veterinary;
- Pharmaceutical care;
- Rehabilitative and prosthetic care;
- Home care;
- Hospital care access;
- Access to residential and semi-residential care;
- Counseling for childhood, motherhood and the family;
- Information and administrative assistance for the use of various health and social services.
General Practitioners (GP or MMG), Pediatricians (PLS) and the Medical Guard (Guardia Medica)
GP, PLS and the Medical Guard are doctors who work with the health service (in agreement) and they represent the first approach to check the health of adults and children assessing the treatment they need and regulating the access to other services offered by the NHS.
General Practitioners (GPs)
Doctors who provide medical examinations, basic medications (suture and disinfect small wounds), and can issue medical certificates (for work, the gym, etc.). It is very important that between the General Practitioner (GP) and the patient there is a good relationship of mutual trust. The GP, after a visit, can considered being appropriate to go deeper, with other exam or with the advice of a medical specialist, the health of his patient.
Among the services provided by the health system there are also the visits performed by a specialist that must be booked in territorial or hospital clinics or in private accredited clinics.
To obtain a specialist visit (cardiology, dermatology, etc.) or a specialized examination (CT scan, ultrasound, etc.) a prescription, with the request and the motivation reported on, is required. For tests and specialist visits the patient will have to pay, unless exempted, a flat fee that can vary depending on the type of examination or test performed.
How to choose a GP
Each citizen has the right to choose his General Practitioner. To locate the person you want, you can consult the lists of physicians affiliated with the National Health System, available in the offices of the health district area. Some Local Health Authorities have made possible the consultation of these lists also online, while the National Federation of Associations ofMedical Doctors and Dentists (Fnomceo, see linkhttps://portale.fnomceo.it) shows on its website a list of all licensed doctors, divided by region and category even if you have to already know the name of the doctor. On this database you can learn some interesting data as year of birth, graduation year, the acquired specialization.
Before making our choice, it is a good idea to make an appointment with your doctor and go to the clinic in person to a first meeting, also with the aim to understand if it is available to welcome you among his patients and to know the schedule of visit. Each physician, in fact, can assist a limited number of people.
The final choice, valid for one year and automatically renewed, must be communicated to the Registry Offices of the Health District ofResidence by presenting the Health Booklet (see below).
The first time you choose him, you must also present a valid identity card and the Health Card (see below).
Tessare sanitaria / health care
The same office can be contacted at any time to communicate the revocation of the GP or the change of the doctor in favor, for example, of a GP of a clinic closest to your home.
Don’t forget that also the GP has the right not to take care of you anymore by sending a communication with the reasons to the Local Health Authorities that shall inform you promptly.
They are specialists who work with children who have up to 14 years of age, and they guarantee specific health care and prevention of disease, since from the first months of life.
He is the children's doctor also crucial for health education, and he is compulsory up to age 6. After this age parents can choose to stay with the same pediatrician up to 14 years, or choose a GP for the child.
If the child is suffering from chronic diseases or disabilities, the
entry can be extended up to 16 years.
To enroll a newborn to the Health Registry you need to bring the Health Card of the newborn and his birth certificate.
Medical Guard (Guardia Medica, also known as Continuità Assistenziale)
They are doctors who take the place of the GP when the GP is not available: from Monday to Friday working from 8.00 P.M. to 8.00 A.M. and from 10.00 A.M. of Saturday (or of the day before a holiday) to 8:00 A.M. of Monday (or the first working day after a holiday).
The Medical Guard provides urgent visits directly at home and can only prescribe medicines deemed necessary for the patient. The service is free for residents while the citizens of other regions may have to pay an amount for office or home visits.
It is a very important service especially because it can avoid the unjustified recourse to the Emergency Room (Pronto Soccorso).
Contributing writer Daniele Tari is a medical doctor specializing in radiology. He graduated from the University of Naples, Italy. In his free time he is an active composer and piano player for his band, Sipario Metal.