Italians have a sad saying: ‘health is a right in the north, and a hope in the south’.
Despite recent improvements, regional differences in healthcare standards continue to plague the country, telling a ‘tale of two Italies’ with the country divided in half, and featuring a trend of southerners travelling north for treatment.
The south-north healthcare gap of the past has of course significantly shortened. Things are very different now from the days when Turin doctor Carlo Levi wrote ‘Cristo si è fermato ad Eboli’ (Christ stopped at Eboli) in 1945, when he talked about the shock of seeing poor children in Matera, the capital of Basilicata, with flies in their eyes and infections.
Today, Basilicata leads southern regions on healthcare performance. And there are significant differences in standards between southern regions, with Calabria and Molise lagging behind Sicily, Puglia and Campania for treatment and services.
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But differences remain, and the pandemic has worsened the outlook according to a recent report by the government’s CNEL agency.
Public healthcare expenditure is at a national average of 1,838 euros per person per year. But the figure is much higher in northern regions than in the south: for example, it’s 2,255 euros in Bolzano versus 1,725 euros in Calabria.
This translates into lower investments in healthcare in the south, ranging from research in medicines and therapies to top doctors and avant-garde treatments.
Waiting lists in the public healthcare system for checks and surgeries are longer in the south than in the north, where all the best doctors tend to be. I’ve met many southern doctors who, after studying abroad, ditched their native regions for Rome or Milan where most of the top-rated clinics and hospitals are located.
Lombardy, Piedmont and Emilia Romagna have always shone when compared to Sicily and Calabria. And even Rome, despite being the capital, lags behind Milan.
However there have been a few improvements in southern standards lately, and the situation varies depending on the type of treatment.
According to the 2021 public hospitals performance report (PNE), even though the north is showing better results in terms of treatments for cancer and orthopaedics, the poorer southern regions are raising standards in some areas.
For instance, among the top 10 facilities with higher proportions of primary angioplasty guaranteed within 90 minutes, a good index of appropriateness and timeliness, seven are based in the south.
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Still, the gap has led to a type of ‘health tourism’ within Italy. There are no statistics, but I’ve met many southern people who have had to fly to the north for particular treatments, access to top doctors and cutting-edge surgeries, for example for knee and hip replacements.
They rented apartments or stayed at hotels for weeks after their surgery to undergo rehab and physiotherapy, at considerable extra expense.
I’ve met others who had to fly from Salerno and Puglia to Millan and Bologna for hip, shoulder and knee joint reconstruction or replacement, with all the hassle of the journey in poor health and the extra transport and accommodation costs it entails.
It was striking to find that many Romans are among those who regularly travel to Milan for heart and orthopaedic checks and surgeries. Rome does have a few top-rated clinics, but apparently not as many as Milan.
Meanwhile many doctors from Milan, Padua and Bologna come ‘fishing’ for desperate patients in Rome and Naples who have failed to find a surgeon willing to operate on them due to their complex conditions.
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This healthcare gap in my view will never completely disappear, despite the incoming European funds through the pandemic recovery plan aimed at shortening it.
It will be further reduced in time, but not in the near future, particularly if all the good doctors continue to flee north for higher salaries, prestige and a more promising career.