Italy's health system versus the NHS
The embarrassing Olympic opening ceremony was watched by hundreds of millions of people with far better health systems than ours. Italy, as Tim Hedges recounts, just wipes the floor with the NHS. Why are we in denial?
Ten o’clock and the hospital is settling down for the night. Visiting hours ended long ago but there are still people milling around, ciao-ing and talking on their mobile phones.
Someone, incredibly, has lit an incense stick, perhaps to complement the televised Sunday mass; the spicy perfume permeates the corridors and wards. Italian canzone play through an ancient transistor radio and the noise from the tinny loudspeaker makes the crooner sound like a muezzin. The ambience is of the souk.
I have been in hospital in Italy. There is a lot of foreign-ness in the Italian health system, decent food being one obvious difference -- properly al dente pasta, main course, vegetable and fruit twice a day. But there is a lot we would recognize and even envy.
One thing in particular is the kit: whatever the latest thing is, it is here. A few years ago, a claustrophobic friend who needed an MRI scan and could not face going into the tunnel asked about a new, open scanner. The nearest one was about fifteen miles from her remote Umbrian village.
She learned later that at the time there were only a couple of these in the whole of the UK. Hers had been in a privately owned clinic, of which the Italian Health Service was a customer. The clinic was owned by a British company.
The hospital I was in was well staffed, excellent nurses and auxiliaries (who do six months training) always on hand. All the staff spoke perfect Italian. There were no bodies in the corridor.
In Italy I don’t have to make a long-term appointment to see a doctor, I just join a usually short queue. There's a doctor available out of hours and at weekends. When I needed a non-urgent X-ray I went to book it up on a Friday and was given an appointment for the Sunday afternoon.
Italy comes second (to France) in the WHO assessments of European healthcare. However, whilst France is generally regarded as having slung money at the issue, money which it can ill afford, Italy has not. Government expenditure on health per head is 20 percent less than Britain’s.
The structural differences between the Italian and British systems are marked. One of the most interesting is that health is not an object of endless political carping here. In Britain, whenever I hear a politician of whatever stripe saying they will improve healthcare for the elderly, I assume the money will be taken quietly from the children’s leukaemia budget.
The Italian system is regionalised. The twenty regions compete for funding from Rome. This saves a level of bureaucracy; what a retired NHS professional friend calls ‘checkers checking the checkers’.
You often pay something: for example a visit to a non-urgent specialist was €20, although these charges are waived for pensioners and the unemployed. Prescriptions are charged at four rates, from zero for the exempt categories to quite exorbitant for those earning more than €100,000 per year.
The Italian state picks up the tab for around 60 percent of the nation’s health. In Britain it is over 90 percent, the poor paying for the rich.
The Italians are not scared of private sector involvement: their system is not ideological, just based on delivering good healthcare to sixty million people.
I am not saying the system is perfect: I was told the main hospital in Catania, Sicily, ran out of lavatory paper for a week.
What I do say is that the faults with the British system are symbolized by the phrase ‘our NHS’: a willingness to close our eyes to its failings and to kid ourselves it is the envy of the world. The embarrassing Olympic opening ceremony was watched by hundreds of millions of people with far better systems than ours, who would not have dreamed of bragging about it.
Britain needs to look, modestly, at what others have. It needs to ask why the NHS is one of the largest employers in the world whereas the French system is not. It needs to ask whether a better system could be had for less.
Tim Hedges, The Commentator's Italy Correspondent, had a career in corporate finance before moving to Rome where he works as a freelance writer, novelist, and farmer. You can read more of his articles about Italy here
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