Right to health, Italy: medical emergency and emergency room, a snapshot of the healthcare sector in a country that is walking on the road to differentiated autonomy

ROMA – The levels of healthcare are not uniform throughout the national territory and this causes healthcare mobility which gives the image of an Italy split in two, divided between those who seek treatment where they live and those who change regions to access medical assistance .

Fewer and fewer general practitioners. Not only that: the National Health System has fewer and fewer general practitioners – in 2026 there will be 135 fewer than in 2022 – fewer and fewer emergency doctors – 45 percent of those who retired in 2023 have not been replaced – fewer and fewer nurses – on average in Italy there are 6.2 per thousand inhabitants, a number well below the OECD average of 9.9. Hospital facilities and beds are also decreasing. This is the photograph of the national healthcare system taken during the event held in Rome “#SALUTE24 – Public health: the differentiated autonomy of the Regions in the Health Union”.

The nodes of differentiated autonomy. In the center the major theme of the differentiated autonomy process that began in 2017 and reached the Constitutional Affairs Commission of the Chamber of Deputies on 14 February. If the bill is working in the direction of allowing local authorities to identify even different paths to guarantee homogeneous essential levels of performance, effectively expanding the powers and responsibilities of the Regions, the question on the table is whether differentiated autonomy will really succeed to mend the differences between Regions in the health sector and to revive the National Health System. At the event, organized by the editorial platform WitHubtogether with the Brussels-based news site Eunewsto the news agency GEA Green Economy it’s at Foundation art.49.

Health mobility. That what emerges is the gap between the different Italian regions, which is why many citizens decide to seek treatment in a different region than their own. According to the data AGENAS (National Agency for Regional Health Services), the trend of hospitalization mobility in Italy, from 2017 to 2022, is constant, with a balance of just under 3 billion euros per year. The winners were Lombardy and Emilia-Romagna, with a positive balance of almost 362 million euros for the former and 337 million euros for the latter. Veneto follows, with 107 million euros, Tuscany, Piedmont, Molise and Trento. The rest of the Regions had a negative balance in 2022, with Campania, Calabria and Sicily in the last positions.

The health leak. But which are the Regions that have the highest flight rate, i.e. those in which citizens move to other areas to obtain adequate medical services? Molise holds first place for passive mobility, with a total escape index corresponding to over 38 percent. In second place Basilicata and then Calabria. Healthcare mobility is not the only critical issue of the healthcare system. The accessibility and quality of healthcare is in fact also threatened by the lack of doctors, in particular by those who guarantee the primary presence in the area: general practitioners. A general practitioner can have up to 1500 patients – in particular cases it can reach 1800 – yet according to a GIMBE re-elaboration based on Ministry of Health data, in almost all Italian regions as of 1 January 2023 aAt least half of the doctors in each Region have a number of patients exceeding 1500. Some examples: 71 percent of general practitioners in Lombardy have over 1500 patients, followed by the autonomous province of Bolzano, with 66.3, and Veneto with 64.7 percent. High numbers also for Valle D’Aosta with 59.2 percent, for the autonomous province of Trento, 59.1 percent and for Campania, 58.4. Emilia Romagna is also just above 50 percent. Friuli Venezia Giulia, Piedmont, Sardinia, Marche, Tuscany, Liguria and Lazio are however close to the 50 percent threshold.

The future. This picture of the present shows no signs of improving if we look at the coming years. If we calculate the balance between retirements in the 2023 – 2026 time frame and the number of scholarships financed for the Training Course in General Medicinesecond GIMB, in two years the number of general practitioners will decrease by 135 units compared to 2022, with clear regional differences: Campania, Lazio and Puglia will lose 384, 231 and 175 doctors respectively, while Emilia Romagna, Veneto and Lombardy will have an active balance of 170, 183 and 328 doctors. In general, most of the central-northern regions will be active.

The emergency room crisis. In 2023, according to the data Sime (Italian society of emergency medicine), four thousand emergency doctors were short of what was needed. Also in the past year, 1,033 doctors left the emergency room, compared to 567 new entries and this means that the 45 percent of those who left were not replaced. To cover shifts in the face of an obvious staff shortage, the solutions adopted range from the use of atypical contracts, in 54 percent of cases; in the use of doctors from other departments: 48 percent of cases; in the involvement of emergency-urgent specialists: 32 percent of cases; in the use of cooperatives, 28 percent of cases. This emergency situation has led over 300 thousand people, in 2022, to have to wait up to 3 days to obtain a hospital bed, reports the Patient’s Rights Tribunal.

The nurses. According to the latest data, relating to 2021, the average number of nurses in Italy is 6.2 per 1,000 inhabitants, compared to the average OECD of 9.9. Also in this case, the clear division between north and south returns with Friuli Venezia Giulia, Emilia Romagna and Liguria among the Regions with the most nurses, while Calabria, Sicily and Campania are bad with an average of 3.8, 3.77 and 3.59 nurses per thousand inhabitants.

Hospital facilities and beds. According to the data reprocessed by analyzing the Istat database “Rappello Noi Italia 2023” and the I.Stat portal, in 2004 Italy had 1,296 hospital facilities including public ones, those treated as public and private ones accredited with the National Health System. In 2021 they dropped to 1,051, with a decrease of -19 percent and, if Lombardy is excluded, all the Regions have decreased their hospital supply or left it intact. Between the worst performance emerges from Lazio: -42 percent from 2004 to 2021. Things are no better for those looking for a bed in ordinary hospitalization: in 2004, in Italy, the offer was equal to 231,915, which then fell to 209,568, with a decrease in 10 percent, with Molise and Calabria among the absolute worst.