Health-care inequalities in Italy: challenges for the Government
Authors: Prisco Piscitelli, Alessandro Miani, Alfredo Mazza, Maria Triassi, Antonella De Donno, Antonio Scala, Manuela Pulimeno, Alessandro Distante, Fabio Pollice, Annamaria Colao
Journal: The Lancet Public Health (2019)

The Lancet Public Health recently addressed the challenge of coping with health inequalities in Europe,1The Lancet Public HealthAchieving health equity in the European region.Lancet Public Health. 2019; 4: e482Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar and others have highlighted the problems affecting the Italian health-care system with its dearth of doctors.2La Colla L Health worker gap in Italy: the untold truth.Lancet. 2019; 394: 561-562Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 3Paterlini M Italy calls on retired doctors to fill health worker gap.Lancet. 2019; 3931492Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 4GBD 2015 Healthcare Access and Quality CollaboratorsHealthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015.Lancet. 2017; 390: 231-266Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar Considering these challenges, we believe the recently appointed Italian Government should focus on correctly implementing the law introduced in the early 1990s, with the aim of planning access to medical schools in advance, on the basis of future needs, rather than cutting the number of medical students. We recommend Italy should guarantee that all new doctors can enter specialisation schools within a few years of completing their degrees. Additionally, the so-called brain drain issue should be addressed; thousands of doctors and researchers trained in Italian public universities left the country during the past decades2La Colla L Health worker gap in Italy: the untold truth.Lancet. 2019; 394: 561-562Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar because of the scarcity of opportunities, bureaucratic delays in recruitment procedures, the prominent role of trade unions,5Regini M Regalia I Employers, unions and the state: the resurgence of concertation in Italy?.West Eur Polit. 1997; 20: 210-230Crossref Scopus (75) Google Scholar inadequate salaries, and poor career prospects based on measurable results (ie, meritocracy). Additional problems appeared after the constitutional reform in 2001, which produced a shift from nationally to regionally based organisation of health services, increasing the inequality between northern and southern Italy without reducing the costs of the system.6Di Novi C Piacenza M Robone S Turati G Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy.Reg Sci Urban Econ. 2019; 78103465Crossref Scopus (28) Google Scholar Finally, substantial technological discrepancies persist between small hospital facilities and big university hospitals, and between the public and private sectors. In our opinion, the quality and attractiveness to heath workers of the Italian health-care system can be improved only by linking medical care and research, with an ethical and meritocratic approach. We believe that research and innovation are the only solution for health-care inequalities. Indeed, many people assume that when medical and scientific research are prioritised, citizens receive a better quality of medical care than when it is not. Therefore, a large number of patients move from southern to northern Italy, which they associate with medical research excellence. We believe all actors within the health system (including general practitioners, specialists, nurses, and administrative staff) should be involved in research by collecting clinical records, introducing innovative information and communications technology solutions, and increasing the currently low level of digitalisation, telemedicine, big data management, and home-based assistance, particularly for patients with chronic conditions and older patients. A new, empowered role of medical professional associations (eg, OMCEO at Lecce and FNOMCEO) is needed to attract talent by funding PhD positions (as is done in Lecce), promote international twinning of hospitals, and widely improve health at the local level, especially in disadvantaged areas. Only through such efforts aimed at promoting individual and collective health can the Italian Government stimulate good quality care everywhere (including in peripheral locations), increasing social cohesion, patients' trust, and doctors' motivation to fully implement their mission. All authors declare no competing interests. Achieving health equity in the European regionOn Sept 10, 2019, WHO published a report , Healthy, prosperous lives for all: the European Health Equity Status Report, which reviews progress and gaps in achieving health equity in the WHO European region and provides critical evidence to inform governments in designing their policies and foster action. Health equity implies that everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential—this report, unfortunately, reveals that progress towards health equity in many of the 53 countries of the WHO European region is stalling. Full-Text PDF Open Access