Health, split Italy: South in crisis for essential services

It is better to get sick in Emilia Romagna or in Veneto, rather than in the South or in the Islands. This has been known for some time, but which shows no signs of being less true than in the past: now even the official government numbers confirm that, in health care, Italy is divided in two. Efficient services almost everywhere in the Center-North, serious and sometimes very serious shortcomings in the South. The last picture of the situation is taken by the report on Lea, that is the essential levels of assistance: in practice, the minimum services that the national health service must guarantee .

The research, relating to 2019 and recently published by the Ministry of Health, once again shines a spotlight on the worst quality, at least in general, of assistance guaranteed to the sick in the southern regions. Sardinia is not among the six regions that do not guarantee the basic levels, in whole or in part; but it ranks just above the sufficiency line.

Before Covid

As a photo of the situation, it is clearly a bit dated: the reference year of the report concerns the pre-Covid era, when the pandemic had not yet shocked the world (and health facilities in particular). The complete data for 2020 are not yet known. But there is no reason to think that, at this juncture, the gap between best and worst has narrowed. On the contrary. It must be said that, among the six rejected (or postponed) areas, two are in the far north: the Aosta Valley and the Autonomous Province of Bolzano. But they are very peripheral and sparsely populated. Overall, the scores accumulated since Florence are very good.

The other four regions that have not achieved all the essential objectives are Sicily, Calabria, Basilicata and Molise. As shown by the reworking of Salutequità, an independent association that monitors the state of Italian health, only Calabria obtains an insufficient score in each of the three fronts on which the evaluations are articulated: namely the area of prevention, hospital and district (medicine territorial). If in the first area Calabria reaches 59.90 points out of a maximum of 100, one step away from the sufficiency which coincides with 60 cents, the evaluation of the hospitals remains very negative: just 47.43. A middle ground (55.50) is the score of the district area.

Bolzano, on the other hand, is doing well on the hospital front (72.79) but rather badly in the other two areas. The remaining regions are "in the red" only in one area for each: Sicily lacks prevention, Molise in hospitals, Basilicata and Valle d'Aosta in the districts.

Scores in the Island

Sardinia gets a fair score only in the prevention category: 78.30, in any case the last among the “promoted” regions. It is saved by a hair - 61.70 - in the district area, and is just better as far as hospitals are concerned, with 66.21. Another southern region, Campania, has similar performances to those of the island: a little worse in the hospital area (60.40), slightly higher in the district (63.04) and in prevention (78, 88).

Remaining in the Sardinian reality, it is fair to point out that the disappointing score of the district area is largely due to the lack of complete data with respect to many of the items that make it up. Especially those on home and residential care for the elderly, disabled, mentally ill. In the next few years, a more diligent response by the Region to this type of evaluation, still at an experimental stage, could tell a less deficient reality. Among the data that are better, however, should be noted - in the area of prevention - the vaccination coverage of children for some types of diseases (while the island was late, in 2019, in the extension of the flu vaccination); health protection in the workplace; defense from animal diseases transmissible to humans and from contamination of food of animal origin. Overall, the composite index on lifestyles is very good for Sardinians. Also satisfactory, passing to the hospital area, the rates of admissions and their appropriateness.

Still too many inequalities

According to the general classification, the regional healthcare that overall best guarantees the Lea is Emilia Romagna: it does not stand out in any area, but in all three it ranks on a flattering score of 94 and change. In terms of prevention, only Umbria slightly surpasses it, which however drops significantly in the district area, where the record is instead of Veneto, with an exceptional 97.64. However, the latter region also obtains excellent ratings on the other sides, so its average of 92.81 is the second overall after Emilia.

The best hospital situation seems to be that of the Province of Trento, which reaches almost 97 out of 100. Among the other central-northern regions, Lombardy, Piedmont and Tuscany are on very good averages, followed at a short distance by Liguria, Marche and Friuli . Already mentioned of Umbria, the scores drop a little - but always at more than acceptable levels - with Lazio and Abruzzo, while they drop significantly, as we have seen, when it falls below Rome. With one exception: Puglia, which hits the average of 76, just three points, for example, from Friuli.

According to Tonino Aceti, president of Salutequità, the inequalities in access to health services are still too wide, represented by the gap between the best and worst performances between the regions: over 40 points of difference for prevention, about 50 for the district level and 48 for the hospital area. “The situation of the regional health services is more serious than these data”, underlines Aceti, however, “the range of scores between the regions continues to be too wide. And the gap between the results of the Regions is a gap between the rights of citizens, which must be eliminated ”. Now it will be necessary "to publish the 2020 data immediately - concludes Aceti - because only in this way will we be able to measure the real resilience of the regional health service in the assistance provided to non-Covid patients in the midst of the pandemic".