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HEALTH

How bad is Italy’s north-south ‘healthcare gap’ really?

Despite recent improvements, stark regional differences in healthcare provision persist in Italy and the problem seems to be here to stay, writes Silvia Marchetti.

Published: 9 December 2022 16:31 CET
How bad is Italy’s north-south ‘healthcare gap’ really?
The hospital in Locri, in Italy’s southern Calabria region, which regularly sent patients elsewhere due to a lack of doctors and equipment even before the pandemic. (Photo by Gianluca Chininea / AFP)

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.

READ ALSO: Five essential facts about Italy’s public healthcare system  

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. 

The Policlinico A. Gemelli Hospital in Rome. Italy’s capital is home to several highly-rated hospitals and clinics, but some residents still travel north in search of better or faster treatment. (Photo by Filippo MONTEFORTE / AFP)

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.

READ ALSO: Who can register for national healthcare in Italy?

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. 

READ ALSO: The parts of Italy with the best (and worst) quality of life in 2022

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.

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WORKING IN ITALY

OPINION: Why a ‘posto fisso’ work contract is still the Italian dream

What type of job do Italy's graduates dream of landing? For many, being employed by the state is the ultimate goal. Silvia Marchetti explains what's behind the intense competition for 'posto fisso' jobs in the public sector.

Published: 18 March 2023 15:20 CET
OPINION: Why a ‘posto fisso’ work contract is still the Italian dream

The dream of many Italians is to secure a permanent job contract either in the public or private sector – preferably in the public sector – and I know this fixation baffles many foreigners. 

There is a widespread belief, based on reality, that once you are a public employee hardly anything could cause you to lose your job.

The public sector is preferred to the private simply because it guarantees a more stable, secure life-long job that makes families confident about their future, and able to look ahead with optimism and make plans.

The state doesn’t usually fire employees (unless you do something extremely bad), and even the private sector decides layoffs only if there are very sound reasons, because contracts and trade unions protect employees.

There is an obsession in Italy with the so-called posto fisso, meaning a permanent job, even if the workforce has to migrate across the country.

READ ALSO: What to know about getting an Italian work permit in 2023

The fact that this type of job is the dream of most freshly graduated young people has a lot to do with family education and mentality.

Many Italian parents educate their children on the life-mission of securing a posto fisso, a bit like marrying, buying a house and having kids. And so children grow up with this ultimate goal in their mind, and the belief that having a permanent job with all the benefits, the paid pension schemes, paid holidays, sickness days and severance pay would make their life perfect.

Historic post office building in Italy

A permanent job contract in the public sector is the dream of many Italian graduates. Photo by Sara Cudanov on Unsplash

It would give them total security, and is seen like stare in una botte di ferro (literally meaning “being in an iron barrel”).

Italy has one of the world’s highest rates of spending on social security (second only to France, according to the OECD), and each year more resources are earmarked. This has also impacted on the approach towards work. Everyone wants a slice of the (public) pie.

It still astonishes me listening to many young people chatting on the beach about securing that permanent job, even if it’s not what they like, but they have already calculated what they will be earning over the years, and what their pension would likely be.

Italians generally don’t have much of an entrepreneurial spirit of ‘let’s live life, and work, as an adventure’. There’s a bit of a negativity around going freelance or registering as self-employed, becoming a libero professionista, for it is seen as scary and yielding a highly unstable and insecure future solely based on what you earn, which is really never a fixed amount each month.

Unlike abroad, Italian parents don’t all support libera professione (self-employment) and most would rather see their kids settle down with a safe job contract. Remote workers and freelancers are often looked down upon compared to those with a posto fisso, as if there existed an intangible work hierarchy made of unreachable privileges.

READ ALSO: Reader question: Will Italy follow Spain in introducing a digital nomad visa?

Many friends of mine got the long-coveted posto fisso because their parents were retiring and managed to exchange their retirement with a permanent job for their kid within the same firm or public body.

Police, nurse, firefighter, teacher and public administration jobs are the most wanted, because they’re for life. To get kicked out you must do something very horrible because the type of contract secures your position.

It doesn’t matter what it takes to land a posto fisso. Many friends of mine had to relocate to other cities, either in the very north, or in the very south, to be able to later find a permanent job in Rome, for instance as a middle school teacher.

There was one lady who, in order to teach on her native island off Rome’s coast where she lived, had to go all the way to work in a Basilicata school to get the job she wanted 10 years later on her home island.

Sometimes freshly-hired young people have to commute for hundreds of kilometres per day just to work fuori sede (out of the area) for a few years before landing a position in their own province.

Train station in Rome, Italy

Young Italian graduates often have to commute for hundreds of kilometres every day just to work. Photo by Chad Greiter on Unsplash

A scuba diver friend of mine who works in the fire brigade toured nine northern cities in order to finally settle down in his native Sicily where he could put to use his diving skills in deep Sicilian waters, rather than climbing frozen trees in Treviso to rescue cats.

Public jobs come with huge ‘competitions’ (concorsi pubblici) with thousands of applicants for just a few hundred, or less, available places. The numbers are impressive because the state must allow everyone who meets the required criteria to participate – but then just the lucky ones make it through, and then they often end up on waiting lists anyway.

READ ALSO: The jobs in Italy that will be most in demand in 2023

Every time I pass a major Carabinieri military police station in Rome I see young people lined up for exams and they really have miserable faces, having traveled probably hundreds of miles that same day.

State exams for qualified professions such as lawyers are also massive in terms of applicants. The cost to the state is relatively low compared to the time and money applicants must waste on taking part, given that they often have to pay to access state exams.

But there’s also the other side of the coin: exploiting ‘geography’ can come in handy. Surprisingly, attending a state exam to become a lawyer in certain remote southern regions where there are few applicants, thus less competition and easier tests, increases the chances of passing those exams.

Many people I know who failed the state exam for law in Rome after three consecutive attempts eventually passed it in deepest Molise or Abruzzo. They then went back to Rome or Milan to work in some fancy attorney office.

I don’t think Italians will ever get over the posto fisso obsession – unless merit and entrepreneurship are more effectively supported with targeted policies.

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