Giuseppe Milanese appointed chairman of the Italian Confederation of Health Cooperatives

The map of inequality: with over 20 million Italians in financial difficulty going without treatment or getting into debt to receive it, health becomes a commodity only available for those who can pay. Cooperatives are a third way to support the Italian national health service.


Only those who can afford it can access healthcare: with more than 5 million poor people (ISTAT, the Italian National Institute of Statistics), healthcare represents, more than any other indicator, the litmus test of the social and economic hardship of the country. 12.2 million Italians forgo healthcare due to economic difficulties; over 7 million have got themselves into debt in order to access it and 2.8 million have sold their homes to meet the costs of healthcare (source: Censis, Italian social study and research institute). Eleven million people have insurance to cover healthcare. These numbers map the striking inequality of a country where only those who can pay can get treatment. As cooperative members and as citizens, we do not want a health care system that is only for those who can afford it. Giuseppe Milanese, appointed chairman of Conf-Cooperative – Sanità (the Italian Confederation of Healthcare Cooperatives), gave his warning at the national assembly held in Rome, during which the revised data on ISTAT and CENSIS sources were reported. IHCO President Carlos Zarco, gave a presentation on the different roles that health cooperatives develop in the health systems of several countries.

Hospitals alone are not enough. «Forty years after it was established, the Italian national health service is experiencing an unprecedented crisis. The result is overcrowded hospital facilities, where a hospital stay costs as much as 700–800 euros per day. With this money, ten people could be seen at other types of health facility every day. The solution must start with a grass-roots approach – a primary healthcare system, a complex and widespread network able to take care of citizens’ needs for healthcare provision directly in the heart of the community, with hospitals providing only the most important treatments and interventions» stated Milanese.

Demand is growing, but there is a shortfall of doctors and services. In the next few years, with the way demographic trends are going, we will have on the one hand a growing demand for services, while on the other, a progressive decline in the number of doctors and nurses employed in the national health service. In 2015 alone, there were 10 thousand employees fewer than the previous year. Between 2009 and 2015, the number of jobs lost totalled 40,364. This situation is destined to worsen if we consider that the average age rose in 2015 from over 53 for doctors and over 47.4 for nurses (data from the Italian Ministry of Economics, 2016). In the next five years, in fact, we will see an exodus of 30,000 doctors, which will cause a 30% drop in services. Already today the shortage of anaesthetists (4,000) means one intervention in three is not performed.

«The problem lies in the fact that the drastic reduction of admissions and days of hospitalisation,» Milanese observed, «does not correspond to the development of an integrated healthcare system nationally. In this way, waiting lists are lengthened, which is the main reason why Italians turn to private facilities, where they face higher costs. Just one example is that for a mammogram, the average wait is 122 days, which in the south increases to 142».

The system is unprepared for the demographic future of the country, there are 4.5 million disabled people (including over 2 million in particularly serious conditions), 30% of whom live alone, with this figure reaching over 42% in the case of disabled people over 75. There are only 250,000 beds in residential and semi-residential facilities for elderly people who are not independent – only ⅓ compared to France and ¼ that of Germany – a situation that is likely to worsen over the next few years at an estimated rate of 8,000 beds every year. Social and healthcare services are facing the same shocking issues – they treat only 760 thousand of the possible 2.7 million elderly people who are entitled to and need them. The issue runs deep – continues Milanese – then there is the geographical divide of the country: 69% of health and social care residences are in the north, and only 7% in the south, where families themselves provide many welfare services, but this is not enough to meet the demand.

It is not a question of spending, but of reorganising services in a changing country with an ageing population. The health costs paid by private individuals has reached 40 billion euros in the last year (+10.3% between 2012 and 2017). The public sector, on the other hand, accounts for 75% of current healthcare expenditure and during the same period recorded an average annual growth of 0.5% compared to that of households, which has increased on average by 2% annually. This situation impacts heavily on low-income households: seven out of ten state that health expenditure has a heavy impact on the family budget, while 47% say they cut down on other expenses to pay for healthcare (ISTAT). The problem is not spending in itself. We do not demand to increase it but to optimise it, considering that out of 26 billion of spending on long-term care (LTC), only 588 million goes into services and the rest into monetary transfers.

Secondly, we ask for services to be reorganised effectively, to respond to the needs of a country that is continuously changing and with an increasingly older population. «In this framework, we believe that cooperation in healthcare provision is the way forward in order to give the system the overhaul it needs. A middle ground, between the state and the market, which takes the form of a multi-professional and integrated network of cooperatives of doctors, health workers, pharmacists and mutual health organisations, which aim to support the Italian health service as a subsidiary, not just as service providers, but co-responsible for delivering services to citizens. A valuable tool,» Milanese concluded, «to reduce inequality and counteract the creeping privatisation of the Italian national health service.»