According to a study published by The Lancet Public Health magazine, coordinated by the Burlo Garofolo Pediatric Institute in Trieste, Italy's health system was among the 10 best in the world. Italy ranks ninth in the Global Burden of Disease ranking, behind Iceland, Norway, Netherlands, Luxembourg, Australia, Finland, Switzerland, and Sweden. Service quality was measured using the HAQ (Health Access and Quality Index), which considers various parameters of the health system and access to cures and treatments.
The institution of the Servizio Sanitario Nazionale (SSN), in Italy, through Law No. 833, of 1978, is considered a big bang reform, that is, it introduces significant changes in the operationalization of systems. This law introduced a new operative system to carry out not only curative and rehabilitation actions, but also preventive actions, aiming to raise individual and collective well-being.
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The SSN is based on three fundamental principles: universality, equality, and justice. This means that public health must serve all citizens without distinction, with the same quality. Although there are similarities between the Italian health system and the health system of other countries, such as Brazil, for example, one of the main differences is the so-called Sanitary Tickets, which emerged as a way to enable the State to act in the face of the fiscal crisis of the late 1980s and early 1990s.
The Health Ticket represents a quota of direct participation of citizens in public expenditure, in return for the health care provided by the State. Article 8 of Law No. 537 of December 24, 1993 (Italy, 1993) presents general rules for the use of the Ticket, but over the years, several legislative measures have changed the nature and mode of use of the Ticket system. As of 2001, the responsibility for standardizing the use and payment of the Ticket has been delegated to regional authorities, which therefore vary from region to region.
Currently, the Ticket is provided for three types of health care: emergency care, white and green codes (assistances not classified as an emergency), with a base rate of 25 euros; some categories of medications, specialized consultations, and diagnostic tests. It should be noted that there are exemptions applied to pregnancy, chronic diseases, people with disabilities, or people seeking a diagnosis concerning HIV and cancer. Citizens over 65 are also exempt from paying the Ticket.
Who is entitled to Public Health in Italy?
To access the public health system, you must be registered in a comune in Italy, as a resident. This applies to Italian citizens and foreigners living in Italy legally. In case you didn't know, a comune (or comuna) is similar to what we call a municipality in Brazil, and each comune has a representative leader, called sindaco, a position equivalent to the mayor.
The next step is to gather the necessary documentation to apply for enrollment in the public health system. The documents required are:
- Permesso di soggiorno - residence permit, also called residence permit;
- Codice fiscale - instrument for the identification of individuals and other entities, other than individuals, in their relations with Public Bodies and Administrations;
- Certificate of residenza - a document that proves that the citizen is effectively resident in that comune.
Once this is done, it is necessary to go to the Azienda Sanitaria Locale (ASL) or Health Company in your region, to register your data. When you register, you must choose a family doctor (doctore di famiglia), who will be the health professional responsible for accompanying you for the rest of your life. The services provided by the doctore di famiglia are free, and he is the one who makes the referral to specialists in the public network.
Finally, you will receive the Tessera Sanitaria. The Tessera Sanitaria is a personal document issued to all Italian citizens entitled to services provided by the National Health Service, and it is necessary to present it whenever you need medical attention. Since 2011, the Health Card has been replaced by the Tessera Sanitaria-Carta Nazionale dei Servizi (TS-CNS), equipped with a microchip.
It is possible to take several exams for free through the SSN, but in most cases, it is necessary to pay a fee (ticket Sanitario). Depending on the type of exam, there may be a long wait to get a seat to take the exam. However, if you are willing to pay the full amount, you can do it more quickly through private clinics.
When blood tests are needed (blood count, blood glucose, cholesterol, etc.), you can ask your GP to provide you with a guide called impegnativa. For this, it is necessary to present Tessera Sanitaria, and only then will he print the guide and sign it.
The scheduling of exams must be done at the Centro Unico di Prenotazione (Single Scheduling Center), but it can also be scheduled in pharmacies that have the CUP system, as well as in hospitals. However, to book exams through pharmacies, there is a charge equivalent to €1.50. As for the exams, they can be done either in public hospitals or in private clinics (when they are paid for).
Pharmaceutical assistance tickets and exemptions
Concerning reimbursement by the National and Regional Health Service, medicines are divided into two classes:
- Class A drugs (essential drugs and drugs for chronic diseases): These are drugs, under the responsibility of the SSN, used in serious, chronic, and acute diseases. All drugs considered essential to ensure the care provided for in the Essential Levels of Health Care (LEA) are included in Group A.
- Class C drugs (non-essential drugs): They are medications entirely under the patient's responsibility and used for minor pathologies, or considered minor, which, therefore, are not considered "essential".
Regarding these parameters, for non-exempt patients, the maximum value of the medicine ticket is €2.00 per package and €4.00 per prescription.
The flat fee is also valid for equivalent and non-patent (or generic) drugs. If the citizen does not accept the substitution proposed by the pharmacist or the doctor has expressed irreplaceability, the difference between the reference price and the price of the medicine prescribed by the doctor is due. This additional fee is not only due in case the drug is unavailable at the lowest regional price.