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People get sick, then die of health system. In a utopian Italy such things should not be, considering that the right to health is enshrined in the Constitution among the key principles of our legal system. Yet, it does happen. Sometimes because of the doctors’ and nurses’ “oversights”, sometimes because of the inefficiency of our health care system, clogged by long waiting lists and more and more expensive. These discouraging factors push one citizen out of ten not to cure themselves. This is what comes out of the last Civic Watch report on federalism in health by Cittadinanzattiva, which was recently presented in Rome.

The report shows it clearly: in the regions of the country, the outlay for these services is higher, due to an increased private spending for services and taxation, the basic levels have less warranties than elsewhere. An insult to efficiency and equity. An Italian out of four, among the 26 thousand who have appealed to the Tribunal for Patients’ Rights in 2015, lamented the difficulty of accessing medical visits joining waiting lists (over 58%) and tickets (31%). The residents of Calabria, Friuli Venezia Giulia, Liguria, Marche, Sicily and of the autonomous provinces of Trento and Bolzano and Veneto have protested the most against the excessive waiting time for the visits and tests.

In total, 7.2% of Italians have chosen to cure themselves. 5.1%, that is, about 2.7 million people, did so for economic reasons, the rest because of the long waiting times. The southern regions have the majority share of waivers (11.2%), followed by the Centre (7.4%), and in the end there is the North (4.1%). Besides, the lists are not the same for everyone: for instance, for an orthopedic visit, the minimal waiting time was recorded in the Northeast (little more than a month), whereas the highest ones in the Centre (almost two months); for a first consultation with cardiology ECG one has to wait from 42.8 days average in the northwest to 88 days in the Centre; for a full abdomen ultrasound one has to wait from a minimum of 57 days in the North East to a maximum of 115 days in the Centre; for motor rehabilitation, waiting time ranges from almost 13 days in the North East to almost 69 days in the South.

In general, on a sample of 16 health care visits, minimum waiting times are all recorded in the North East or North West, whereas the longer waiting time, in 12 cases out of 16, is reported in the Centre. In the South, and particularly in Campania and Puglia, citizens resort more often to private specialists to avoid the problem of long queues in the public health care system.

Also as far as tickets are concerned, there are big regional differences: on the same 16 health care visits, the cheapest tickets are concentrated mainly in the North East (10 of 16), whereas the most bitter ones in the South. The level of citizens’ contribution to the tickets from 2013 to 2014 decreased only in the region of Trento (-5.6%), in Sicily (-2.2%), Piedmont (-2%) and in Liguria (0.8%). In Valle d’Aosta, instead, it increased by 11.9%. Every year, citizens pay on average more than 50 euros each in the shape of revenue share in all the Northern and Central regions, with the exception of Piedmont, Marche and of the province of Trento, whose peaks almost touch 60 euros in Veneto and Valle D’Aosta and an average of 42 euro in the South.

Then there is the prevention alarm. Out of the 16 regions monitored by the Ministry of Health, in 2013 only 50% were in line with the directives of the Ministry: Basilicata, Emilia Romagna, Liguria, Lombardy, Marche, Tuscany, Umbria and Veneto. Yet, three are steps backward compared to 2012 (-7.5% Basilicata, Liguria -7.5%; Veneto -10%). And among the eight defaulters (Abruzzo, Calabria, Campania, Lazio, Molise, Piedmont, Puglia and Sicily), four got even worse (15% Puglia, Sicily -7.5%, Calabria and Campania -5%).

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