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Calabria, almost half of the patients have to move to the North for treatment

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Calabria, almost half of the patients have to move to the North for treatment

In the South, prevention and treatment services are more lacking, public health spending is lower, people travel to other regions to receive assistance. These are some of the data that emerged from the report Svimez One country, two cures. North-South gaps in the right to healthin collaboration with Save the Childrenpresented in Rome.
Increasing health spending is the national priority. Furthermore, the regional distribution method of the National Health Fund should be corrected to take into account the greater care needs in the areas with the highest socio-economic disadvantage. Differentiated autonomy risks widening inequalities in the conditions of access to the right to health. These are the main considerations present in the report.

Only 6.6% of GDP for the National Health System

The territorial gaps have increased in a context of general weakness of the National Health System – NHS which, in European comparison, is undersized for allocations of public resources: in media 6.6% of GDP, compared to 9.4% in Germany and 8.9% in France. This in the face of a comparatively high private contribution24% of overall health spending, almost double that of France and Germany. Monitoring essential levels of assistance – Leawhich offers a picture of the differences in the effectiveness and quality of the services provided by the different Regional Health Services – Ssr, highlights the disappointing results of the South: five regions of the South are in default.

Two different treatment systems

«This report is a snapshot of the healthcare system that highlights a country with two completely different healthcare systems, which are drifting apart over time» the general director of Svimez tells VITA Luca Bianchi. «The data we present show how, after Covid, there has been a weakening of health policies in Italy, on a general level, and all Italian regions are paying for it. This inevitably leads to an ever-increasing gap, especially where the system is more fragile such as in the South. A fact for everyone, to help us understand how the North and the South are two different worlds, is provided by the tumor screenings promoted at a regional level. We have levels ranging from 12% in Calabria to 80% in Emilia Romagna, which means that 12 women out of 100 are contacted in Calabria to carry out tumor screening, while in Emilia Romagna it is 80 out of 100: this determines a greater possibility of getting ill and a lower survival rate for women in the Southern region”.
According to the evaluations of the Istituto Superiore di Sanità – ISS, in the two-year period 2021-2022, in Italy approximately 70% of women aged 50-69 underwent checks: approximately two out of three did so by joining the free screening programs . Overall coverage is 80% in the North, 76% in the Center and drops to 58% in the South.

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In the South, lower life expectancy and higher mortality from cancer

«We have data on life expectancy and cancer mortality that are moving away between the South and the North. This is a worrying fact, if we think that three years ago we were in the midst of Covid and we were reflecting on how we needed to strengthen the National Health System, on how no one could do it alone and we returned to a logic of absolute selfishness, abandonment, weakening of the South” , continues Bianchi. The Southaccording to the BES (Equitable and Sustainable Wellbeing) health indicators, it is the area of ​​the country characterized by the worst health conditions. The indicators relating to life expectancy show a marked and growing territorial differential over the years: in 2022, life expectancy at birth for southern citizens was 81.7 years, 1.3 years less than the Center and North-West, 1.5 compared to the North-East. Similar unfavorable differentials in the South are observed for avoidable mortality caused by deficits in health care and in the provision of prevention services. The mortality rate from cancer in the South is 9.6 per 10 thousand inhabitants for men compared to around 8 in the North. The gap for women has grown: 8.2 in the South with less than 7 in the North.

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With differentiated autonomy the crystallization and widening of gaps

«Reading the data from the report, we have a further concern regarding differentiated autonomy. We send a message that is completely opposite to that of differentiated autonomy», continues the director of Svimez. «Let’s say that, to make the healthcare system universal, we need to focus on the national system, we need to balance services between the various areas of the country. Instead differentiated autonomy is the model that would lead to the crystallization and widening of gaps. It would mean that each region tries to do it alone».

Healthcare mobility: it is “escape” from the South

The report clearly shows the “escape” from the South to receive assistance in health facilities in the Center and North, especially for the most serious pathologies. «The data on healthcare migration is impressive» continues Bianchi. «Not only do we have regions in which over 40% of people go outside their own region for treatment (this concerns all the regions of the South and now also the Centre), but it also introduces a self-sustaining mechanism. The people who leave are resources who move from a poor region to a rich region to compensate for healthcare costs, therefore giving more budget to the rich regions, taking it away from the weaker ones.”

VITA has dedicated a series of articles to the topic of healthcare migration:

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In 2022, of the 629 thousand healthcare migrants (volume of hospitalizations), 44% were residents of a region in the South. For oncological pathologies, 12,401 southern patients, equal to 22% of the total patients, moved to receive treatment in an SSR in the Center or North in 2022. Only 811 patients from the Centre-North (0.1% of the total) made the reverse journey. Calabria records the highest incidence of migration: 43% of patients turn to healthcare facilities in non-bordering regions. Followed by Basilicata (25%) and Sicily (16.5%). In the South, prevention and treatment services are therefore more lacking, public health spending is lower, and the distances to travel to receive assistance are longer.

1.3 million minors in (health) poverty

«From the point of view of child care, Italy is excellent and remains so. We have a universalist NHS, which welcomes all children and families free of charge, even in emergencies. This is a value that we must never forget”, he tells VITA Raffaela Milan, responsible for Save the Children’s Italy – Europe Programmes. «In this context it is true that inequalities are increasing and especially affecting poverty. This data cannot be separated from the number of children and adolescents in conditions of absolute poverty, 1.3 million, for whom poverty becomes health poverty. Precisely in those areas of the country where the health offer should be stronger to compensate for these difficulties, instead it is weaker”, continues Milano.

In 2022, of the 629 thousand healthcare migrants (volume of hospitalizations), 44% were resident in a region of Southern Italy

Pediatric healthcare migrations are growing

«Health migration is a very important topic in our country, especially when it comes to children because it is the whole family that is affected by this situation. Healthcare mobility leads us to say to be careful when talking about differentiated autonomy. The starting picture is already so unequal that we must not risk inequalities widening.” Save the Children highlights growing numbers also in pediatric healthcare migrations from the South to the Centre-North, a sign of deficiencies or mistrust in the healthcare system of the Southern regions: the escape index – i.e. the number of pediatric patients who go for treatment in a region other than that of residence – in 2020 it stood on average at 8.7% at a national level, with territorial differences ranging from 3.4% in Lazio to 43.4% in Molise. In particular, a third of children and adolescents travel from the South to receive treatment for mental or neurological, nutritional or metabolic disorders in specialist centers, converging mainly in Rome, Genoa and Florence.

Fragmentation and desertification of professionals

«From our observatory a fragmentation emerges which adds to the South-North inequalities as it concerns widespread issues such as the desertification of professionals and services», he said Anna Lisa Mandorino, General secretary of Active Citizenship. «General practitioners and nurses are in short supply in the North more than in the South, but are generally lacking in internal areas, as are some services characterized by high innovation and specialization. In this picture the reform of differentiated autonomy, on which we continue to reason (moreover with very little involvement of citizens) without the definition of the essential levels of services, gives the only certainty that of amplifying this fragmentation and giving us a country further divided in the guarantee of the right to health».

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1.6 million Italian families in health poverty, 700 thousand in the South

Based on recent assessments by the Center for Applied Economic Research in Healthcare – Crea, 6.1% of Italian families are in healthcare poverty, because they have encountered difficulties or have given up on healthcare expenses. There are 1.6 million Italian families in health poverty, of which 700 thousand are in the South. In the South, health poverty affects 8% of families, a double percentage compared to the 4% in the North-East (5.9% in the North-West, 5% in the Centre).

Opening photo: Ieo Hospital in Milan, inauguration of the new Ieo Proton Center pavilion. (LaPresse)
Photos of the event courtesy of the Save the Children press office.

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