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УДК: 614.39(450)
YE. BEKMUMAMBETOV1, M. VALENTI2, G. ZHURABEKOVA3, S. KUMYSPAYEV4, S.RAKHMANOV5
NATIONAL HEALTH SYSTEM IN ITALY: DEVELOPMENT STAGES,
STATUS AND TRENDS
Marat Ospanov West Kazakhstan State Medical University1'3,4,5, Aktobe Environmental Medicine and Clinical Epidemiology section Department of Applied Clinical Sciences of the University of L'Aquila2, Italy PhD, professor1,2, PhD, associated professor3,5, magister4
Annotation. In the article is considered the peculiarities of formation and development of the health care system in Republic of Italy. Main stages of the development, conditions and tendencies in the context of the social development of medicine are showed. Structure, goals and objectives of the National Health Service are disclosed. In the article described the reasons for the length of life of the citizens of Italy, shows the factors reflecting the mentality of Italian citizens to proper nutrition. Subjects of articles cover a range of topical problems of the national health care system in Italy in the context of the geographical location of the state. Also the economic, political and demographic factors are analyzed that influence on the health care of Italy. Considerable attention is paid to the statistics and estimates of the World Health Organization. The comparative analysis in the field of medicine and health care in Italy with other states of the European Union is given.
Key words: health system, health care, treatment, health planning, life expectancy.
Recent studies have shown that the Italians are the most healthy people with the longest life. Argues that this is due to red wine, olive oil and the Mediterranean diet. Of course, it is also associated with the health system in Italy. Dwell on it.
Italy's national health system (Servizio Sanitario Nazionale or SSN, for short) is administered through local health authorities and provides low or no-cost health care to all EU (European Union) citizens, including in-patient treatment (including tests, medication and surgery during hospitalization), visits to family doctors and medical assistance provided by pediatricians, obstetricians and other specialists. It also pays for part, sometimes all, of the cost of drugs and medicines, out-patient treatment and dental treatment. Emergency health provision is available to all EU and non-EU visitors. Regardless of where you come from, you must have some form of health insurance as soon as you arrive in Italy. A permesso di soggiorno (Residence permit) will not be issued without it.
Health care spending in Italy accounted for 9.0% of GDP in 2006 (about $2,600 per capita) of which about 75% is public [1], slightly more than the average of 8.9% in OECD (Organisation for Economic Co-operation and Development) countries [2]. In the WHO's (World Health Organization) last health care ranking in 2000, Italy's healthcare system was regarded as the 2nd best in the world after France [3], and according to the CIA World factbook (Central Intelligence Agency), Italy has the world's 10th highest life expectancy [4]. Thanks to its good healthcare system, the life expectancy at birth in Italy was 80.9 years in 2004, which is two years above the OECD average [5]. After World War II Italy (re-)established its social security system including a social health insurance administered by sickness funds. In the 1970s the social health insurance faced several equity problems as coverage differed between the sickness funds and around seven percent of the population remained uninsured. Moreover, sickness funds went practically bankrupt by the mid-1970s. Due to growing public dissatisfaction with the existing healthcare system, Italian policymakers fostered a structural reform. In 1978, the government established the SSN -the Italian version of a National Health Service - including universal coverage and tax funding [6].
The aim of the SSN was to create an efficient and uniform health system covering the entire population, irrespective of income or contributions, employment or pre-existing health conditions. The SSN provides free or low-cost health care to all residents and their families plus university students and retires (including those from other EU countries) and emergency care to visitors, irrespective of their nationality.
In 1998 the SSN was separated from the INPS and funded directly by central government via the IRAP tax (Imposta Regionale Sulle Attivita Produttive), which is paid by employers on behalf of employees; the self-employed pay for themselves through their taxes. You don't pay direct contributions and need only be a resident in Italy or a citizen of the EU to receive the same health benefits as an Italian.
If you qualify for health care under the SSN, your dependants receive the same benefits and are listed on your card. Dependants include your spouse (if she isn't personally insured), children you support who are under the age of 16 (or under the age of 26 if they're students or unable to work through illness or invalidity), and ascendants, descendants and relatives by marriage supported by you and living in the same household.
If you aren't entitled to public health benefits through payment of Italian taxes or by receiving a state pension from another EU country, you must usually have private health insurance and must present proof of this when applying for a residence permit. If you're a retired EU national planning to live permanently in Italy, you need form E121. EU citizens who retire before qualifying for a state pension can receive free health cover for two years by obtaining form E106 from their country's social security department. If the temporary cover expires before you reach retirement age, you need to make voluntary social security contributions or take out private health insurance.
Healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service which is organized under the Ministry of Health and it's administered on a regional basis. The Ministry of Health, which coordinates the national health plan, subject to the constitutionally guaranteed powers of the Regions;
А number of offices and organizations at the national level, such as:
- the Board of Health (CSS);
- the National Institute of Health (ISS);
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- the National Institute for Occupational Safety and Prevention (ISPESL);
- the Agency for Regional Health Services (ASSR);
- institutions of care and treatment of a scientific nature (IRCCS);
- institutions zooprophylactic experimental;
- the Italian Medicines Agency (AIFA);
Regional health services. These, in turn, comprise:
- the regions and the autonomous provinces of Trento and Bolzano;
- the local health authorities (ASL) and hospitals (AO), through which the regions and the autonomous provinces provide health care.
Health Planning
The NHS is characterized by a system of health planning, governed by 1 of Legislative Decree no. 502/1992, which are the following:
- in the National Health Plan;
- in regional health plans.
The National Health Plan for three years (although it can be changed during the three years) and is adopted by the Government on the proposal of the Ministry of Health after hearing the competent parliamentary committees, as well as the most representative trade union confederations, taking into account the suggestions made by the regions.
It shows:
- the priority areas of intervention for the purpose of a progressive reduction of social inequalities in health and territorial;
- essential levels of health care to ensure for the period of validity of the Plan;
- the capitation funding secured to the regions for each year of the Plan and its breakdown by levels of care;
- guidelines aimed at steering the NHS towards the continuous improvement of quality of care, including through the implementation of projects of supraregional;
- projects target, to be achieved also through the functional integration and operation of health services and social services of local authorities;
- the general purpose and main areas of biomedical research and health care, including providing its research program;
- the requirements relating to basic training and addresses for the training of staff, as well as the needs and the development of human resources;
- guidelines and related diagnostic and therapeutic pathways in order to foster within each health facility, the development of methods systematic review and evaluation of clinical practice and care and to ensure the application of the essential levels of assistance;
- ^tena and indicators for the verification of levels of care insured in relation to those expected.
Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients are assigned a doctor by the SSN but if they are dissatisfied with the assigned doctor they are free to change doctor, provided the doctor they choose has free slots.
Prescription drugs can be acquired only if prescribed by a doctor. If prescribed by the family doctor, they are generally subsidized, requiring only a copay that depends on the medicine type and on the patient income (in many regions all the prescribed drugs are free for the poor). Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be sold in specialized shops (farmacia). Visits by specialist doctors or diagnostic tests are provided by the public hospitals or by conventioned private ones, and if prescribed by the family doctor require only a copay (of the order of $40 for a visit without any diagnostic test) and are free for the poor. Waiting times are usually up to a few months in the big public facilities and up to a few weeks in the small conventioned private facilities. Patients, however, can opt for the «free market» option, provided by both public and private hospitals, which is paid completely out-of-pocket and has generally much shorter waiting times. Surgeries and hospitalization provided by the public hospitals or by conventioned private ones are completely free of charge for everyone, regardless of the income. For the planned surgeries waiting times can be up to many months, especially in big cities.
The emergency medical services in Italy currently consist primarily of a combination of volunteers and private companies providing ambulance service, supplemented by physicians and nurses who perform all Advanced Life Support procedures. For example, one of the cars of «first» in the city, the birthplace of the great Italian cyclist Marco Pantani, was presented to the local hospital, the official fan club. The emergency telephone number for emergency medical service in Italy is 118. First aid is provided by all the public hospitals. For urgent cases it is completely free of charge for everyone (even for the undocumented). A copay (about $35) is asked for non-urgent cases.
Emergency medical services are under Public Health Authorities control in each Italian Region; the ambulance subsystem is provided by a variety of different sources. Italy is known for its generally good health, considering the fact that it has the world's 10th highest life expectancy [7], low infant mortality, relatively healthy cuisine and diet, and healthcare system that is ranked second according to WHO (World Health Organization) [8] and which has the third best medical performance worldwide [9]. As with any developed country, Italy has adequate and sufficient water and food distribution, and levels of nutrition and sanitation are high.
Food and nutrition. Italy is known for its healthy and nutritious cuisine. Italy's nutritious and generally healthy cuisine ensures that Italians are well-nourished and eat good food. Promotion of correct dietary and lifestyle habits is one of the primary objectives of INRAN (National Food and Nutrition Research Centre) [10]. In 1986, a committee of experts drafted the first dietary guidelines for a healthy Italian diet. These have since been modified and now contain various updated revisions and specific targeted advice. By offering definite advice and suggestions as to the correct choices in relation to good dietary practices, the dietary guidelines aim to prevent the risk of diet related chronic degenerative pathologies, and to promote health status, physical well-being, and an active and dynamic lifestyle. In addition to the dietary guidelines, the organization's Web site
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offers popular and informative publications/papers, as press communications and promotional videos.
In this context, the Italian researchers [11] have reported that, typically, the media covers a range of different nutritional topics. Many radio and TV shows dedicate special seasonal editions to diet and well-being and present technical reports on different nutritional issues. The print media also devotes attention to the subject of nutrition. An analysis of nutrition coverage in the Italian press in 2009 revealed 10 weekly newspapers, 15 women's magazines, and 4 weekly cooking magazines that regularly published articles on nutrition. Recent market research [12] showed a 30% increase in the use of nutrition and well-being Web sites over the last 3 years, with the sites being accessed from home- and work based computers. Moreover, thousands of Internet Web sites often access to nutrition data; it should be noted, however, that many of these sites lack quality control. As an example, when the keywords «dieta», «nutrizione», «centri di dietica e nutrizione», were entered into the search engine Google in November 2009, 29 500 000, 1 090 000, 22 000 results, respectively, were entered.
Life expectancy and mortality. Italy has one of the highest life expectancies in the world. However, Italy's high average varies greatly by regions. In the more affluent north, the life expectancy at birth in 1990 for a man would be lower than in the south (73.3 compared to 74.2) yet for a woman, the average is higher in the north than in the south (80.6 compared to 79.8) [13]. Central Italy has the highest average, with 74.7 for men and 81.0 for women [14]. In 2003, the average national life expectancy at birth for a woman was 78~84, and for a man 71~77 [15]. By 2009, this average had rapidly increased to 77.26 for men and 83.33 for women [16].
Italy also has a very low rate of infant mortality that of 5.51 out of 1000 people, the 185th lowest in the world [17]. From 1970 to 1989, the death rate went down dramatically, from 11 and 10.3 for men and women, to 8.3 and 6.7 [18]. Health service reform is a matter of intense public debate in Italy. The budget for the 2012 National Health Fund amounted to 108.78 billion euro, of which 106.21 (funding LEA) [19] to be distributed among the 20 Italian regions [20], which, however, have not yet received appropriations [21]. The sharing of Italian citizens to national health expenditure is equal to an amount of € 4 billion [22]. Public health expenditure was 76% and private health expenditure 24%. When the data are subdivided by area (Northern, Central and Southern Italy), the expenditure was 56.24% in Northern Italy, 56.39% in Central Italy, and 52.05% in Southern Italy [23]. In our opinion, the upcoming parliamentary elections February 2013 issue of Health and reform will be very relevant to the people of Italy. It is called the primary health care system a possible victim of politics economy. Approximately 60% of citizens believe that the country is «urgently needed» medical reform, and another 24% said it «desirable». In general, the Italians believe that the health system must operate on a market basis. More than two-thirds of respondents (69%) believe that the quality of care would be improved if patients can do more to control health care costs. A 55% of Italians believe: it would be much easier if patients use health services for their own money [24].
There are other interesting studies that reflect the mentality of Italian citizens. Concerning the public sphere, there is a strong sense of community and high levels of civic participation in Italy, where 91% of people believe that they know someone they could rely on in time of need, in line with the OECD average. Voter turnout, a measure of public trust in government and citizens' participation in the political process, was 81% during recent elections; higher than the OECD average of 74%. Social and economic status can affect voting rates; voter turnout for the top 20% of the population is 88% and for the bottom 20% it is 81%, in line with the OECD average gap of 7% [25].
According to the experts of the World Health Organization, health by 20-22% depends on heredity, by 18-20% - on the environment, by 7-12% - from the organization of health services and to 50-52% - of living. A way of life is above all physical activity, that is, physical education and sports. There are many Italian people are involved in sport. Apparent success in sport also affects the consciousness of citizens. In the street you can see a lot of people who run, do sports walking. Many of them are older people. Thus, there is prevention of many diseases.
Kazakhstan necessarily needs to use the success of the Olympic Games in London to promote a healthy lifestyle. In his last message to the «Strategy «Kazakhstan-2050»: a new policy established state,» President Nursultan Nazarbayev has devoted considerable attention to the development of healthy lifestyle and sports. In particular, the President noted that a healthy lifestyle, physical training is the key to a healthy nation.
It is very important to hold and convey to the public that the best prevention of the disease than his subsequent treatment. We believe that the experience of Italy is very relevant. Especially in the field of nutrition, lean attitude to health, prevention of socially significant diseases and organization of sports events.
Improving the health of citizens and the increasing life expectancy of Kazakhstan, reduced disability are the key to sustainable social and demographic development of the country. In this regard, the State program «Salamatty Kazakhstan», the President, provided for strengthening preventive measures, screening, improving the diagnosis, treatment and rehabilitation of basic social diseases. List of the Literatures:
1. «World Health Organization - Italy». WHO. 2010. Dev.prenhall.com. Retrieved 2 August 2010.
2. «OECD Health Data 2008 How Does Italy Compare». OECD. 2008.
3. http://www.photius.com/rankings/healthranks.html.
4. https://www.cia.gov/library/publications/the-world factbook/rankorder/2102rank.html.
5. «OECD Health Data 2008 How Does Italy Compare». OECD. 2008.
6. http://www.sfb597.uni- Frisina Doetter, Lorraine and Götze, Ralf (2011) «The Changing Role of the State in the Italian Healthcare System», TranState Working Papers No. 150)
7. https://www.cia.gov/library/publications/the-world- factbook/rankorder/2102rank.html.
8. http://www.photius.com/rankings/healthranks.html.
9. http://www.photius.com/rankings/world_health_performance_ranks. html.
10. Instituto Nazonale di Ricerca per gli Alimenti e la Nutrizione. Linee Guida per una sana alimentazione. 2003; Available at; http//www.inran.it/Accessed 12 November 2009.
11. Hellas Cena, Carla Roggi, Lucio Lucchin , Giovanna Turconi. Nutrition Reviews September 2010, p 561.
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12. Nielsen Media Research. Pharma Health. Healthy, beauty and personal grooming. 2007; Available at: http:/www.Nielsen. com. Accessed 12 November 2009.
13. http://www.euro.who.int/document/hms/ehiexes
14. http://www.euro.who.int/document/hms/ehiexes
15. http://www.wh o. i nt/co untries/ita/en/
16. https://www.cia.gov/library/publications/the-world- factbook/geos/it.html
17. https://www.cia.gov/library/publications/the-world factbook/geos/it.html
18. http://www.euro.who.int/document/hms/ehiexes
19. «Riparto e obiettivi di Psn martedi in Stato-Regioni: ecco i testi. Allarme per voci di un nuovo rinvio» da S.I.Ve.M.P. veneto. it «Riparto e obiettivi di Psn martedi in Stato-Regioni: ecco i testi. Allarme per voci di un nuovo rinvio» da S.I.Ve.M.P. veneto.it)
20. «Sanita: il riparto delle risorse 2012» da regioni.it
21. «Saltano Stato-Regioni e Unificata per il silenzio del Governo sul riparto del fondo sanitario 2012»)
22. «Sanita: Bissono (AGENAS), Italiani pagano 4 MLD di ticket, serve equita» giovedi 17 maggio 2012 da regioni.it
23. http://www.ncbi.nlm.nih.gov/
24. Disney et al., Impatient for Change, pp. 111-19.
25. http://www.oecdbetterlifeindex.org/countries/italy/
Е.Ж. БЕКМУХАМБЕТОВ1, M.VALENTI2, Г.А. ЖУРАБЕКОВА3, С. КУМЫСПАЕВ4, С. РАХМАНОВ5 ИТАЛИЯНЫН ¥ЛТТЬЩ ДЕНСАУЛЫК САКТАУ ЖYЙЕСI: ДАМУ САТЫЛАРЫ, КАЛЫПТАСУЫ ЖЭНЕ ЖАКСАРУЫ
Марат Оспанов атындагы Батыс Казахстан мемлекегпк медицина университет^3,4,5, Актебе
Л'Акуила университет^, Италия м.г.д., профессор1, PhD профессор2, м.г.к.3,4 ,магистр5
Макалада Италия Республикасындагы денсаулык сактау жYЙесiнiч калыптасу жэне даму ерекшелiктерi карастырылган. Медицинаныч элеуметпк даму аясындагы негiзгi кезечдер^ каз^п жагдайы жэне Yрдiстерi керсетiлген. ¥лттык денсаулык сактау кызмет^ч курылымы, максаттары мен мiндеттерi ашылган. Макалада Италия азаматтарыныч емiр сYPУ узактыгыныч себептерi жэне олардыч менталитетiн айкындайтын дурыс тамактанудыч факторлары сипатталган. Макала такырыбы мемлекеттiч географиялык орналасу контексiндегi Италияныч улттык денсаулык сактау жYЙесiнiч езект проблемаларын камтиды. Сонымен катар Италияныч денсаулык сактау жYЙесiне эсер ететш экономикалык, саяси жэне демографиялык факторлар сарапталган. БYкiлэлемдiк Денсаулык сактау ¥йымыныч статистикалык мэлiметтерiне жэне багалауларына кеп мэн бертген. Италияныч медицина жэне денсаулык сактау саласыныч Еуроодактыч баска елдерiмен салыстырмалы талдауы керсетiлген.
Нег'зг'! свздер: денсаулык сактау щйеа, денсаулыкты коргау, емдеу, денсаулыкты ныгайтуды жоспарлау, вмiрлiк YMim.
Е. БЕКМУХАМБЕТОВ1, М. VALENTI2, Г. ЖУРАБЕКОВА3, С. КУМЫСПАЕВ4, С. РАХМАНОВ5 НАЦИОНАЛЬНАЯ СИСТЕМА ЗДРАВООХРАНЕНИЯ ИТАЛИИ: ЭТАПЫ РАЗВИТИЯ, СТАНОВЛЕНИЯ И ТЕНДЕНЦИИ
Западно-Казахстанский государственный медицинский университет имени Марата Оспанова 1 34 5, Актобе,
университет Л'Акуила2, Италия д.м.н., профессор1, PhD профессор2, к.м.н.34, магистр5
В статье рассматриваются особенности становления и развития системы здравоохранения в Республике Италия. Показаны основные этапы развития, состояние и тенденции в контексте социального развития медицины. Расскрыты структура, цели и задачи национальной службы здравоохранения. В статье охарактеризованы причины продолжительности жизни граждан Италии, показаны факторы, отражающие менталитет итальянских граждан к правильному питанию. Тематика статьи охватывает круг актуальных проблем национальной системы здравоохранения Италии в контексте географического расположения государства. Также проанализированы экономические, политические и демографические факторы, влияющие на здравоохранение Италии. Значительное внимание уделено статистическим данным и оценкам Всемирной Организации Здравоохранения. Приведен сравнительный анализ в области медицины и здравоохранения Италии с другими государствами Евросоюза.
Ключевые слова: система здравоохранения, охрана здоровья, лечение, планирование укрепления здоровья, жизненные надежды.
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Батыс Казахстан медицина журналы №1-2 (38) 2013 ж.
