WHAT'S WRONG WITH AMERICA AND ITALY'S HEALTH CARE SYSTEM

 taken from www.alignedstrategy.com

 

 

HEALTH CARE SYSTEM THE AMERICAN HEALTH CARE “NON-SYSTEM” IL SERVIZIO SANITARIO NAZIONALE ITALIANO AMERICA AND ITALY COMPARED WAITING LISTS WAITING LISTS IN THE AMERICAN HEALTHCARE SYSTEM LE LISTE D’ATTESA NEL SISTEMA SANITARIO ITALIANO AMERICA AND ITALY COMPARED PRIMARY CARE PRIMARY CARE PHYSICIANS IN AMERICA IL MEDICO DI BASE IN ITALIA AMERICA AND ITALY COMPARED HOSPITALS AND EMERGENCY HOSPITALS AND EMERGENCY IN AMERICA OSPEDALI E PRONTO SOCCORSO IN ITALIA AMERICA AND ITALY COMPARED GOING ABROAD FOR MEDICINES GOING ABROAD FOR MEDICINES ANDARE ALL'ESTERO PER COMPRARE LE MEDICINE AMERICA AND ITALY COMPARED SALUTATIONS

 

 

 

INTRODUCTION

 

The aim of this wikipage is to compare the American and the Italian health care system focusing on their problems. As you can see from the table of contents, the page is divided into five parts contaning a description of the American and the Italian situation and a comparison between the two.

Although the two systems work in a different way - the American one is private and the Italian one is public - it is easy to realize that in both there are many inefficiencies.

 

 

 

HEALTH CARE SYSTEM

 

 

THE AMERICAN HEALTH CARE “NON-SYSTEM”

 

 

The American health care system can be considered as a “non-system” because it has a private sector which is concerned with finacning insurace. There is also an insurance contribution from the federal and state Government.

American people can choose among three different possibilities. 60% of the Americans get the insurance through their employer and they pay a premium towards their contribution.^[1] This kind of insurance is now declining because prices and costs have risen. The bigger the company is, the more probable it is that the employer offers benefits of insurance. He subscribes the employee to HMO (Health Maintenance Organization), there is a fixed annual quote and members have to avail themselves of doctors and structures indicated by HMO. The second possibility is to purchase a private insurance. 9%of the population, in particular freelancers and self-employed, can better afford the high costs or private insurance and choose to get it. This way they purchase insurance directly from the market. The rest 27% of the population are covered by Government sources and programmes such as Medicare and Medicade. ^[2]The first one is a national insurance programme for people over 65 years old, while the second one is managed by individual state and it is for families with children, disabilities, pregnancies and elderly.

A big issue that the USA should fight is insurancing people; there are about 41million and they don’t benefit from any kind of insurance. 1/5 of uninsured population is not able to afford its cost and they are predominantly employment-age adults, students, people who work part-time and non-citizens, that is people whose employer do not provide the health insurance or earn too much money to qualify for one of the local or state insurance programme for the poor, but at the same time they don’t have enough money to pay an insurance by themselves.^[3]The impact of the cost of this mixed system is object of debate, in particular questions of access, efficiency and quality purchased. The facility to access the treatments depend on the policy or insurance plan that the patient has subscribed and its cost.

 

 

 

IL SERVIZIO SANITARIO NAZIONALE ITALIANO

 

 

 

 

Dal 1978, l'Italia ha avuto il proprio servizio medico-sanitario nazionale (lo SSN o il Servizio Sanitario Nazionale), simile al NHS britannico  (National Health Service). Il servizio medico-sanitario nazionale dell'Italia garantisce un' uniforme cura completa in tutto il paese. Il Servizio sanitario nazionale è caratterizzato da un sistema di programmazione sanitaria. Lo SSN è sotto il controllo dei governi regionali ed è amministrato dai servizi sanitari locali (Azienda di Sanità Locale/ASL). Lo SSN fornisce la sistemazione dell'ospedale e trattamento, fare la visita ai medici di famiglia , assistenza medica dell'esperto fornita dai pediatri, ostetrici ed altri esperti, medicine scontate, servizi del laboratorio, apparecchi, servizi dell'ambulanza e servizi liberi ad un'unità locale di salute (consultorio). Tutte le medicine sono divise in tre categorie: gratis, caricato a 50% di costo e caricato a costo completo. La carica standard di prescrizione è meno di 10 euro.Tuttavia, questo è complicato dal fatto che,  la responsabilità sanitaria è ripartita fra l'amministrazione centrale e le 20 regioni.

 

Organizzazione

Il servizio sanitario organizza diversi livelli.

Il livello centrale è lo stato. Lo stato ha la responsabilita di provare il servizio a tutti i cittadini. Lo Stato dirige l'intero sistema e regolano i servizi liberi. Il livello regionale è un altro diverso livello nel servizio sanitario.Le Regioni hanno la responsabilità diretta della realizzazione del governo e della spesa per il raggiungimento degli obiettivi di salute del Paese. Le Regioni hanno competenza exclusiva nella regolamentazione ed organizzazione di servizi e di attività destinate alla tutela della salute e dei criteri di finanziamento delle Aziende sanitarie locali e delle aziende ospedaliere (anche in relazione al controllo di gestione e alla valutazione della qualità delle prestazioni sanitarie nel rispetto dei principi generali fissati dalle leggi dello Stato).La prova  suggerisce che lo SSN accerta la parità d'accesso a cura primaria ma le fasce a basso reddito affrontino le barriere dell'esperto. Lo stato di salute degli italiani è migliorato in confronto a quello di altri paesi, anche se alcune disparità regionali persistono.^[4]

 

Molti italiani e stranieri optano per eliminare l'assicurazione pubblica e hanno deciso di comprarne una privatamente. Con l' assicurazione privata, è liberi di scegliere il medico o l'esperto ed essere curati in ospedali privati (cliniche), evitando in questo modo una lunga attesa. Negli ospedali privati, la sistemazione è simile alla sistemazione in hotel (stanze con aria condizionata, stanze da bagno e letti supplementari per i visitori) e le ore di visita sono solitamente senza restrizione. Tuttavia, la qualità della cura medica è probabile essere la stessa che in ospedali pubblici (i medici lavorano spesso sia per il sistema pubblico che per quello privato) anche se non hanno l' attrezzatura medica più aggiornata e possono non avere l'attrezzatura vitale in caso di emergenza. Si noti che il trattamento in ospedali privati in Italia può essere molto costoso. E' bene controllare sempre in anticipo se la propria società assicurativa li copra per il vostro tipo di trattamento particolare. ^[5] Determinate autorità regionali  hanno raggiunto gli accordi con determinati ospedali privati permettendo ai pazienti nazionali di ottenere il trattamento al costo dello SSN. Ciò ha ridotto le code agli ospedali pubblici, ma ha allungato quelle nelle cliniche private. Tuttavia, una decisione recente ha indicato che pazienti di cui la vita è messa da eccessivo fa ritardare nella disponibilità di dichiarano la sanità può andare privatamente, anche senza permesso anteriore dalla regione e caricano il costo allo SSN- è bene per la cittadini dello stato.

 

 

 

AMERICA AND ITALY COMPARED

 

 The main difference between the American and Italian health care systems depends on the private structure, based on insurances, of the first one and the public structure of the second one. American population is divided into 4 parts: people who get an insurance through the employer, people who get a private one and pay it by themselves, people who are covered by the Government and uninsured people, who represents the big problem of the American system. The situation in Italy is different. The State provides and guarantees the service to all citizenzs ad its responsability is shared with the 20 regions. In fact they operate following the State advices in order to achieve the goals that the State has decided. One of the most critical problem of the Italian system is the “malasanità” which is typical of the public hospitals lately. In private structures the quality of the treatments are better and the waiting lists are shorter, but they are much more expensive and most of people who need immediate and important treatments cannot afford their high costs.

 

 

 

 

WAITING LISTS

 

    

 taken from http://www.regione.puglia.it/www/web/packages/progetti/tempidiattesa/images/logo_listat.gif

 

WAITING LISTS IN THE AMERICAN HEALTHCARE SYSTEM

 

Waiting times are a part of every healthcare system and, even if the Canadian situation seems to be the only bad situation, there are often significant waiting times for elective procedures in U.S.A hospitals as well. On average, U.S. citizens experience some of the shortest wait times for non-emergency surgeries among industrialized countries, although the waiting times vary considerably by procedure. Furthermore, the short waiting times apply mainly to those who have insurance; for those who do not, the waiting line is arguably infinite. Moreover, the short waiting lists in the U.S. should be tempered with the realization that the lack of universal healthcare system in the U.S. means less demand for the system. In a cross-national survey of sick adults in five countries, 40% of people in the U.S. said it was either very difficult or somewhat difficult to see a specialist, compared with 53% in Canada. Of the U.S. respondents indicating it was difficult to see a specialist, 40% cited long waiting times. Moreover, 14% of them indicated they had a “big problem” with long waits to get an appointment with their regular doctor. This data show that even if more Canadians than Americans report that waiting times are a problem when trying to see their physicians, some Americans experience this problem as well ^[6]. Although the problem of waiting lists in America is considered not so big, there are also other opinions such as that of Aetna, one of the nation’s biggest insurers, which has admitted to its investors that the U.S. healthcare system is “not timely” and patients diagnosed with cancer wait “over a month” for needed medical care. Lost in the recent flurry of attacks on Canada and other nations with publicly funded healthcare systems, spurred by the popularity of Michael Moore’s “Sicko” ( click to see the trailer), is the reality of the huge hurdles faced by many American patients, said the Physicians for National Health Program and the California Nurses Association. According to recent statistics from the Institution of Healthcare Improvement, people are waiting an average of about 70 days to try to see a provider. Moreover, a University of California San Francisco research report last year documented average waits of 38.2 to get an appointment with a dermatologist to examine a possibly cancerous mole. A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health system, Britain, Germany, Australia, New Zealand, and Canada, found waiting lists were longer in the U.S. than in all the other countries except Canada. Deborah Burger, president of the 75,000-member CAN/NNOC (California Nurses Association/National Nurses Organizing Committee), said that in the U.S. the situation only worsens each year and that’s why U.S. need a single payer system that can respond to new demand. Furthermore, U.S. statistics fail to account for the even longer waits for the 44 million uninsured who put off needed medical care ^[7]. In conclusion, the idea that in the U.S there are no waiting times for the health care is only a myth. The situation is getting worse as these data show: the average wait for a heart attack patient in an ER in 2004 was 20 minutes, compared to 8 minutes in 1997 -  an increase of 150%. But why the waiting times have increased? The answer is simple: demand grew while supply fell. In 1994 there were 93.4 million ER visits, in 2004 they were 110.2 but the number of hospitals offering ERs 24 hours a day were 12.4% fewer ^[8]. Another important aspect in the U.S. are waiting lists for organ transplants: it has increased of nearly 10% in ten years. In 2007 nearly 6,000 people died while on the waiting lists, and more than 26,000 received organ transplants^[9].

 

trailer of "Sicko" by Michael Moore

 

 

Here there is another interesting video about this topic in the U.S.A. by Dr. Elinor Christansen, former President of the American Medical Women's Association: 

 

 

 

LE LISTE D’ATTESA NEL SISTEMA SANITARIO ITALIANO

 

Il problema dei lunghi tempi d’attesa per ricevere prestazioni mediche negli ospedali italiani è un problema molto serio e largamente dibattuto. Se è vero che il fenomeno delle liste di attesa è presente in tutti gli Stati dove esiste un servizio sanitario che offre un livello di assistenza avanzato a prescindere dal modello organizzativo adottato, è anche vero che la situazione italiana è particolarmente grave e lontana dall’essere in linea con gli standard europei. Il rapporto del 2007 di Cittadinanzattiva mostra alcuni dati preoccupanti: ben 540 giorni di attesa per una mammografia e 630 giorni per una visita oculistica. Questi sono soltanto alcuni esempi ma il problema dei tempi d’attesa ricopre ogni ambito sanitario e ogni tipo di richiesta. Quel che preoccupa maggiormente è che i dati, anziché migliorare, con il tempo sono peggiorati:  + 0,9 % rispetto al 2006 ^[10]. Ma cosa sta facendo l’Italia per arginare il problema? La legislazione più recente (2007) prevede l’uso dell’intramoenia – cioè  nell'attività libero professionale dei medici ospedalieri svolta all'interno della struttura pubblica – per il contenimento delle liste d’attesa. Dai risultati del monitoraggio presentati dal Tribunale per i diritti del malato, però, il sistema non sembra aver migliorato la situazione. L'obiettivo dell'intramoenia era di permettere ai cittadini che volevano usufruire delle prestazioni di quel determinato medico, di poterlo continuare a fare, e non certo di rappresentare un escamotage per evitare lunghe liste d'attesa, dove il paziente decide di pagare privatamente un servizio che, in realtà, dovrebbe essere garantito dal servizio sanitario nazionale ^[11]. La realtà dimostra invece che oggi il 30% dei cittadini denuncia di essere stato costretto a far ricorso all’intramoenia a causa delle lunghe liste d’attesa nel canale pubblico ^[12]. Inoltre, nel 2008 è stato presentato il Secondo Rapporto nazionale sull'uso di Internet quale strumento di comunicazione dei dati sulle liste di attesa nei siti di Regioni e P.A. e strutture del SSN: l’intenzione del Ministero della Salute è quella di rendere accessibili e aggiornati i dati riguardo i tempi d’attesa in quanto questa possibilità rappresenta, per la sanità pubblica, un elemento rilevante, ai fini della trasparenza nei confronti del cittadino e degli operatori sanitari^[13] .I fenomeni che concorrono all'allungamento dei tempi d'attesa sono molteplici e complessi. Intanto la crescente richiesta di prestazioni sanitarie, determinata dall'invecchiamento della popolazione e favorita dal progresso tecnologico. In secondo luogo la percezione, da parte dei cittadini, del  proprio stato di salute. C'è poi la valutazione delle necessità assistenziali da parte dei medici (sia di medicina generale che degli specialisti). E infine la disponibilità di adeguate risorse umane, tecnologiche e strutturali da parte dei servizi sanitari, il loro appropriato utilizzo e la complessiva capacità organizzativa ^[14]. Nel sistema sanitario nazionale italiano c’è quindi molto da lavorare e la soluzione non sta semplicemente nell’aumentare i fondi ma nell’organizzare veri e propri piani risanatori che cambino il modo di rapportarsi e gestire il sistema sanitario.

 

 

AMERICA AND ITALY COMPARED

 

 

 

 taken from http://www.swimport.com/plates/947.JPEG

 

 The situation of waiting lists is different in America and In Italy although, through the data that we have already seen, we can say that neither of these two countries have no-waiting lists in their healthcare system. However, the situation in Italy is certainly worsen than that in the U.S.A. because times to receive medical care is surely longer in Italy. For example, to see a dermatologist one has to wait on average 630 days in Italy, while 38.2 in the U.S.A. In both countries the situation about waiting lists is worsening every year and the reason is, more or less, the same: the number of medical care requests is always higher and the capacities of hospitals are always the same. A great difference between the two countries is, however, that in the U.S.A the healthcare system does not have a universal healthcare system because there are millions of uninsured and this means less demand for the system. This is not true for Italy, which provides health care for everybody without any kind of limitation.

 

 

 

 

PRIMARY CARE

 

 

taken from http://www.cartoonstock.com/lowres/for0225l.jpg

 

 

PRIMARY CARE PHYSICIANS IN AMERICA

 

According to the American College of Physicians (ACP), "primary care, the backbone of the nation's health care system, is at grave risk of collapse"^[15]. American primary care is actually facing a confluence of negative factors that are the result of the current dysfunctional payment system for physicians’services.

First of all, primary care physicians can not provide an adequate quality of care for their patients because of the excessive workload they are expected to undertake; it has been estimated that it would take more than 18 hours per working day to deliver all recommended care for patients with chronic conditions and to provide evidence-based preventive care^[16]. The scope of primary care actually extends from uncomplicated upper respiratory and urinary tract infections to the longitudinal care of elderly patients with diabetes, coronary heart disease, arthritis, and depression^[17]. These excessive demands contribute to long waiting times for getting an appointment with a doctor and, above all, to difficult access to primary care for those people insured by the Managed Care system. Many primary care physicians actually prefer not to take such insurances because of the high practice costs and excessive paperwork^[18]; since these insurance policies are very limited in what they will cover patients have to contact their insurance company for pre-authorization or precertification in case of extra coverage and physicians have further bureaucratic requirements that take time away from patients^[19].

Secondly, primary care is under-reimbursed compared to other specialties; specialists typically take home at least double the income of the generalist^[20]. Consequently, as reimbursement is based primarely on the quantity of services delivered (fee for service plan)^[21], rather than on quality, visits tend to be rushed and inadequate for very sick patients with multiple medical problems.

Finally, all these factors are contributing to the increasing problem of primary care physicians’ shortages. Fewer and fewer medical students are choosing careers in primary care at a time of growing need for an aging population with an increased prevalence of chronic disease. Between 1997 and 2005 the number of students entering this field dropped by 50%; in 1998 half of internal medicine residents chose primary care, but by 2006 over 80% became specialists or hospitalists^[22].

 

 

 

 

 

 Video from http://it.youtube.com/: A Crisis in Primary Care

 

 

IL MEDICO DI BASE IN ITALIA

 

In Italia il medico di base dovrebbe essere una figura fondamentale del Sistema Sanitario Nazionale (SSN) con il compito di valutare per ogni paziente le cure necessarie e regolare l’accesso agli altri servizi offerti dal SSN. Tuttavia, nella realtà, le funzioni previste dal ruolo del medico di base spesso non vengono soddisfatte.

Innanzitutto, a causa di un enorme carico di adempimenti burocratici e ad un numero notevole di pazienti da assistere (secondo la convenzione con il SSN fino a un massimo di 1500 pazienti^[23]), il medico di base non riesce ad effettuare una vera visita medica e si limita, quindi, ad un breve colloquio e alla prescrizione di farmaci, esami clinici e visite specialistiche sulla base dei sintomi dichiarati dal paziente^[24]. Le lunghe file d’attesa nell’ambulatorio medico spingono, infatti, il medico a velocizzare il proprio servizio, dedicando a ciascun paziente un tempo davvero esiguo e ritrovandosi a fare lo “smistacode” piuttosto che il medico. La responsabilità affidata al medico di base risulta, dunque, limitata alla scelta immediata di una giusta visita specialistica, anche nei casi in cui il medico potrebbe gestire da sé la situazione che gli si presenta, con piccoli e facili adempimenti che gli dovrebbero competere, potendo evitare al paziente i costi notevoli dello specialista.

Per quanto riguarda i farmaci, il medico di base tende a prescrivere sempre quelli più costosi e quasi mai quelli generici; infatti, a causa di una scarsa disponibilità sul mercato e di poca informazione e promozione, in Italia meno del 2% dei farmaci complessivamente consumati sono farmaci generici^[25].

Infine, nel campo della formazione, l’Italia è uno dei pochissimi paesi in cui c’è la mancanza di  dipartimenti universitari di medicina generale. Tale lacuna ha inevitabilmente un impatto negativo nella formazione pre-laurea e di conseguenza sullo sviluppo professionale^[26]; a causa della scarsa conoscenza e stima che oggi la medicina generale gode in Italia, i giovani medici tendono a non vedere nel loro futuro la medicina generale ma solo l’attività specialistica.

 

 

AMERICA AND ITALY COMPARED

 

Both American and Italian primary care physicians are supposed to be the first point of consultation for all patients. Nonetheless, in America not all people can find a doctor because either they are uninsured or they have Managed Care insurance policies, which involve higher costs and overmuch bureaucratic work for physicians; on the contrary, in Italy primary care is accessible to everybody thanks to a public health care system. Even though in Italy there is more accessibility to primary care, in both countries there are shortages in the quality of care because doctors are overloaded with work and patients are not given adequate attention. Furthermore, it seems that there is no universal definition covering the range of services included in primary care; American doctors actually are expected to perform more functions than Italian doctors are. As far as vocational education is concerned, both American and Italian medical students prefer to become specialists instead of generalists, even though this trend is driven by different factors. Finally, while in Italy it has been shown that only a small number of generic drugs are prescribed by primary care doctors, in America, according to the same source, 43% of the medicines are generic drugs^[27].

 

 

 

 

HOSPITALS AND EMERGENCY

 

 

HOSPITALS AND EMERGENCY IN AMERICA

 

 

For many years, politicians and insurance companies could blithely proclaim that the U.S. had the best health care system in the world, but Americans find it hard to accept this assertion. The 42.6 million people in the U.S. currently without health insurance are acutely aware that the health care system is not working for everyone, and there is growing recognition that the major problems of rising costs and lack of access constitute a real crisis. Health care in the United States is provided by many separate legal entities. Individuals are offered inpatient and outpatient services by commercial, charitable, or governmental entities. ^[28]The healthcare system is not fully-publicly funded but is a mix of public and private funding. The services and facilities that American health care system offers are different. “Ambulatory care" refers to health care delivered without a stay in the hospital; most health care in the United States occurs in the outpatient setting. "Home health care services" are generally nursing enterprises, but are usually ordered by physicians. Private sector outpatient medical care is provided by personal primary care physicians (specialists in internal medicine, family medicine, and pediatric medicine), subspecialty physicians (gastroenterologists, cardiologists, or pediatric endocrinologists are examples) or non-physicians (including nurse practitioners and physician assistants). ^[29]Moreover there are for-profit hospitals, which are usually operated by large private corporations and there are nonprofit hospitals, which may be operated by county governments, state governments, religious orders, or independent nonprofit organizations. Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily they exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. The main problems of American health system are linked to uninsured Americans and to the disparities in access to hospitals and emergencies, which are often made because of different ethnic and racial groups. In particular, the reasons of disparity are:^[30]

• Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines.

• Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.

• Legal barriers. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.

• Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.

• Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.

 

 

 

 

OSPEDALI E PRONTO SOCCORSO IN ITALIA

 

 

 

taken from: http://images.google.it/images?hl=it&q=ospedale&um=i&ie=UTF-8&sa=N&tab=wi

 

Il servizio sanitario nazionale italiano (SSN) venne fondato nel 1978. Esso è caratterizzato da una struttura decentralizzata a causa di una recente politica di devoluzione, che suddivide il controllo e il potere decisionale, affidandoli alle regioni. Esse si trovano così ad avere potere politico, amministrativo e di responsabilità nella gestione delle risorse finanziarie per provvedere al settore sanitario. Lo stato italiano continua ad avere una funzione di controllo e di supervisione, nonché la responsabilità a far sì che il Servizio Sanitario Nazionale assicuri ad ogni cittadino un livello essenziale di adeguata sanità, indipendentemente dalla regione da cui egli proviene. Il SSN è quindi volto ad assicurare l’universalità del suo servizio, senza far distinzioni di stato sociale e offrendo il medesimo accesso agli interventi sanitari che vengono ritenuti necessari ed appropriati per la prevenzione, il mantenimento e la cura dello stato di salute della collettività.

^[31]Il finanziamento del servizio è garantito dal contributi obbligatori dei lavoratori (dipendenti e autonomi) e dei datori di lavoro, integrati da interventi statali per mezzo dei tributi e integrati anche da specifici pagamenti da parte degli assistiti (ticket, tassa per l'assistenza del medico di famiglia, pagamento in tutto o in parte del costo delle medicine).Tali servizi essenziali includono: medicina generale, servizi pediatrici, medicinali di base e quelli specifici per la cura delle malattie croniche, i trattamenti che vengono somministrati durante la convalescenza ospedaliera, le riabilitazioni postoperatorie, gli strumenti e i laboratori diagnostici, e altri servizi specialistici per la diagnosi e la prevenzione.

^[32]Il Sistema Sanitario Nazionale è infine soggetto al controllo democratico del popolo, che lo analizza a livello nazionale, regionale e locale (principio della partecipazione). Esso infatti è strutturato secondo tre differenti livelli: il governo centrale, le regioni e le Agenzie Sanitarie Locali, che formano l’elemento basilare del SSN. Le Aziende Sanitarie Locali, sono enti dotati di personalità giuridica pubblica, di autonomia organizzativa, amministrativa, patrimoniale, contabile, gestionale e tecnica, che provvedono ad organizzare l'assistenza sanitaria nel proprio ambito territoriale e ad erogarla attraverso strutture pubbliche (aziende ospedaliere, ospedali universitari)  o private accreditate ( cliniche private, laboratori di analisi privati, centri di pediatria), tra le quali il cittadino può scegliere indifferentemente. Tutti i servizi, compreso il pronto soccorso 24 ore su 24 anche con l’intervento della Guardia Medica , dovrebbero comunque essere offerti sempre e comunque, nel rispetto delle esigenze del cittadino, che vanno dall’igiene alla necessità di ottenere la risoluzione dei propri problemi.

 

 

 

AMERICA AND ITALY COMPARED

 

 

The U.S. spends more on health care than any other nation in the world. According to the Institute of Medicine of the National Academy of Sciences, the U.S. is the only wealthy, industrialized nation that does not have a universal health care system. In the United States, around 84% of citizens have some form of health insurance; either through their employer (60%), purchased individually (9%), or provided by government programs (27%).

Italy ranks in the middle among European countries in the number of available hospitals and beds, with slightly more than the U.S. The hospital beds in public health facilities are not evenly distributed among Italian regions. Southern regions have fewer than 4.3 beds per 1,000 inhabitants, whereas the northern regions have more than 5.6.14,18 In 1999, the average length of stay was seven days, continuing the downward trend of recent years. Italy has half of the average ratio of personnel per occupied bed of the U.S., which raises questions regarding quality of services and personnel productivity. Italy has the highest density of doctors in Europe, some 350,000, or one for every 163 inhabitants, compared with one for every 400 or so in the United States.

It is possible to evaluate the health care system of a country and especially its organization, that is what citizens can see and use when they need (hospitals and emergency), with respect to some fundamental issues as cost, access to health care and how well health system succeeds in producing good health outcomes in population.

• Good health: making the health status of the entire population as good as possible across the whole life cycle. As regard this point, you can say that there are many different indicators of the overall health status and well-being of a country’s population, but among the most commonly used measures are infant mortality rates and life expectancy. So, comparing Italy’s and America’s data, you can point out that is no a significant difference: 7,2 infant deaths per 1000 live births in America; 6,8 in Italy.

• Responsiveness: responding to people’s expectations of respectful treatment and client orientation by health care providers. In particular, it is important to underline if there is satisfaction with health care system: the U.S. and Italy had the highest level of public discontent. Italy is the lowest among the European Union countries, at 20 percent; U.S. is comparatively low also, with only 40% of people who are satisfied.

For example, from the Italian patient’s point of view, it is not a good service if you go to the hospital and you have to stand in line, if the doctors are arrogant and the quality of service is low. However, for Italian people this would be acceptable, if there won’t be the huge problem of doctors’ mistakes and of the lack of cleanness of hospitals.

• Fairness in financing: ensuring financial protection for everyone, with costs distributed according to one’s ability to pay.  From this point of view, the two systems are different: Italian health care system is founded on this assertion, even if public money are often used to satisfy private practices of some doctors and not to assure a good service, for example in emergency or to buy necessary machinery. On the other hand, the United States has by far the most expensive health care system in the world.

 

 

 

 

 

 

 

 

 

 

GOING ABROAD FOR MEDICINES

 

 

 

GOING ABROAD FOR MEDICINES

 

The American health care system suffers from a big problem with medicines and prescription drugs. It is a very critical issue.

Going abroad to have better care and to get medicines for better price is becoming quite ordinary.

The proximity to Canada, where the prices of drugs are strongly lower, contributes to reinforce this phenomenon.

The number of people who every year overstep the border in order to buy drugs at lower prices is constantly increasing. Re-importing medicines from abroad is not legal but drugs in Canada cost from 30% to 50% less than in the USA and this differece is due to the government imposed controls. According to reliable sources about 1million Americans buy drugs from Canada, that is $40/$60 millions of the trade.^[33] 

Many American states ask now to a bill reduction on imported medicines, but according to the producers it would encourage Americans to buy drugs that do not satisfy Food and Drug Administration standards, because they may not be safe.^[34]

 In the last decades many local advocacy groups, as the Minnesota Senior Federation for example, have started fighting for a bill to legalize drug re-importation and for a honest price of prescription drugs. They still work and their members are increasing. Such associations organize bus trips over the northern Canadian border to buy prescription drugs and then smuggle them back to the USA.^[35] Re-importing is not legal but lots of people cannot afford the high costs of medicines so they cannot refuse such a great ”discount”.Going against federal laws is not acceptable, however  a 40% discount  is a considerable sum that causes many people to go against the law. Some data shows that by 2030 one out of every 5 Americans will be 65 years old or older, this means that more and more people will need to get medicines because of health problems which come at an elder age.^[36]

There is also another problem: many Americans buy their medicines on-line and traditional pharmacies see online drugstores as competitors for supply and pharmacies. This is the reason why traditional pharmacies have put their support behind the drug manufacturers. The difference between them is that manufactures have to notify the board every six months of price increases during that period, instead drug companies were not legally obliged to obtain the board’s approval before raising prices. The role of the board is to avoid excessive increases. What American manufactures want, is a price that is closer to the Canadian one because they do not accept that the same medicine in the USA is more expensive compared to Canada.^[37] Brand name drug makers have tried to reduce the trade from Canada to the USA rising the prices in Canada and imposing new restrictions to the sell in Canadian pharmacies. They have also attempted to avoid Canadian drug exportation. Even though this measure has made the trade a little more difficult, it is has not solved the problem.

 

 

 

ANDARE ALL'ESTERO PER COMPRARE LE MEDICINE

 

 

 

 

1. Nella sezione in alto a destra del fronte della tessera si trova la Data di scadenza: normalmente cinque anni ovvero scadenza dell'assistenza sanitaria
2. In basso a sinistra si trovano tre lettere in formato Braille standard a 6 punti
3. L'area in basso a destra del fronte della tessera sanitaria è riservata ai dati sanitari regionali.
4. Provincia: corrisponde alla sigla della provincia al momento della nascita dell'intestatario, anche se ha subito variazioni successive. Es. un cittadino nato a Fano nel 1970 riporterà come provincia PS (Pesaro) anziché PU (Pesaro Urbino), provincia di recente istituzione.

taken from ^[38]

 

Per gli italiani, qualche volta è necessario andare all'estero. I cittadini possano andare alle paese confinate, come la Francia, la Spagna, o la Germania. Quando loro vanno all'estero i cittadino possano usare la Tessera Sanitaria. La Tessera Sanitaria  è una tessera personale. Ha preso il posto di il tesserino plastificato del codice fiscale per tutti i cittadini.Se un residento in Italia, può applicarsi per usare il servizio sanitario nazionale. Se lavora in Italia e paga i tassi, SSN è liberoda unirsi. Se non lavoro è necessario di pagare cerca 400 euro ricevere il servizio. Se una persona va all'estero e non ha una Tessera Sanitaria, può pagate un prezzo considerevolmente ridotto come 15 euro e ottiene le medicine di sconto.

^[39] La Tessera Sanitaria ha validità 5 anni e in prossimità della scadenza, l'Agenzia delle Entrate provvede automaticamente ad inviare la nuova Tessera a tutti i soggetti per i quali non sia decaduto il diritto all'assistenza. Si richiede la tessera sanitaria al'unità sanitaria locale (ASL) di assistenza. La ASL rilascia una stampa della tessera sanitaria che certifica il codice fiscale in essa contenuto, ai fini della compilazione delle ricette per prestazioni specialistiche e farmaceutiche. Il tesserino vero e proprio sarà recapitato all'indirizzo di residenza nel giro di 15/20 giorni.

 

Il problema sembra essere nel fare domanda per il sanitaria di tessera . Dovete andare alle agenzie differenti ed applicarsi con le varie documentazioni. ASL non chiamata indietro subito ed è ritardato nel loro correspondance. Per alcuni allievi o nuovi immigranti in Italia, per loro è duro infine ricevere la loro scheda. Il sistema di fare domanda per una scheda sembra efficiente, tuttavia una volta che la ricevete i servizi liberi la valgono. Ci sono alcuni paesi in cui il sanitaria di tessera non è accettato come la Svizzera.

 

^[40] 

 

 

 

 

AMERICA AND ITALY COMPARED

 

Again, the two nations seem to have problems in the efficiencies of their health care systems. Going abroad for services is a larger problem for Americans because of the drive for high-cost prescription drugs. The feesibility of going to a nation such as Canda for cheaper drugs is very appealing for American citizens. Italy does not seem to face this problem so much. However, the close vicinity of nations in Europe, allows for Italian citizens to use their tessera sanitaria in various European nations to receive health care coverage. For students, this is great! They do not have to worry about paying for medical necessities. America does not have a comprehensive universal health care system, and therefore is struggling to find a middle ground between the public and private sector. Of course both countries seem to have better health care options in their respected countries, but sometimes due to lack of access are forced to go abroad to receive cheaper, and more readily available drugs or medical services.

 

 

 

SALUTATIONS

 

Thank you for considering our web-site regarding Italian and American health care systems. We hope you found our research helpful and valuable. The list of resources can be found at the bottom of the page in footnotes, and if you wish to contact us please leave comments! We enjoyed working together in constructing this site, and hope it is accessed by various students.

 

Thank you!

 

 

 

 

 

 

 

 

 

 

 

 

 

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