Italy’s healthcare reform

Italian healthcare is still hitting the headlines. Although Prime Minister Mario Monti announced plans for healthcare reform at the end of 2011 – effectively cutting healthcare spend by €2.5 billion, as well as increasing the retirement age – the on-going exposure of hospitals and emergency care failures is drawing huge attention and has even prompted investigations by state prosecutors. Brigitte Dinkloh reports.

Prime Minister Mario Monti
Prime Minister Mario Monti

After two senators inspected Rome’s Umberto I policlinic and discovered an Alzheimer’s patient tied to a stretcher, Health Minister Renato Balduzzi has been sending inspectors to hospitals and the State Prosecutor opened investigations against the emergency units at San Camillo, Tor Vergata and Umberto I. At the beginning of March those investigations were expanded to cover the rescue services, parts of the local health
authorities (Asl) and more hospital departments in the capital region.

The Italian healthcare system needs reform. This much is agreed among citizens venting their anger on internet forums about long waiting periods, over-filled hospitals, deficient hygiene, unfriendly staff – and politicians. Therefore, one of the first reforms to which Prime Minister Mario Monti has committed heavily indebted Italy is also a healthcare reform in the emergency package ‘Salva Italia’. The law, adopted in December— by both chambers of the Italian legislature — inter alia calls for closure of unprofitable hospitals, the introduction of a €10 per diem charge for each day of hospitalisation, limiting free access to regional healthcare centres, and the complete transfer of prescriptions costs to the patients.

In 2012, the state intends to cut a total of €2.5 billion from the national healthcare fund that bears some 40% of the costs of the national healthcare budget. The healthcare reform is thus part of the emergency programme submitted to the European Commission by the Italian government. However, most of the anger in Italy has been caused by the increase in the retirement age. As of 1 January 2012, this was raised for women to 62 years and men to 66. By 2018 it will be increased to 66 for women and 70 for men. The rule by which Italian workers previously were allowed, under certain circumstances, to retire regardless of age after working 40 years, increased at the beginning of the year to at least 41 years for women and at least 42 years and one month for men. In subsequent years this minimum working life will be increased by one month per year.

Whoever begins to collect retirement benefit before the retirement age will have benefits cut by 2% annually. At the same time the benefits increase by 2% annually for each additional year worked after retirement age has been reached. Although life expectancy in Italy continues to increase, the Italian medical associations are very critical of the rise in the retirement age because, in contrast to other European countries, Italy still has no partial retirement rule.

The increase in the retirement age means that even elderly physicians will have to serve and perform surgery, whereby e.g. the association of head physicians (Anaao Assomed) views this as a risk to patient safety. The new retirement rule also does nothing to relieve youth unemployment, currently 31% in Italy. Unlike in industrial enterprises, hospital productivity cannot be raised when neither the number of permanent staff nor the number of beds can be increased. In addition, the inflation adjustor for pensions exceeding €936 has been eliminated for 2012 and 2012.

A minor consolation in future ought to be the supplementary pension payment from the national pension fund for employees of the regional health authorities (Fondo Perseo). However, this is likely to provide only minimal compensation for the cuts in the state pension.


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