4.5 million forego treatment, waiting lists are mainly to blame

The number of Italians opting not to take care of themselves has risen to 4.5 million, both for economic reasons but above all as a result of the waiting lists that have exploded since the pandemic and make it increasingly difficult to access visits and examinations in the health service. It is the too long waits to which patients are forced to subject themselves: in 2019, before Covid, there were just over 1.5 million Italians who, faced with excessively long waiting lists, renounced treatment; in 2023 there will be almost 3 million. Compared to last year, however, the proportion of those who give up for economic reasons is also growing. The merciless numbers that confirm the alarm over the conditions of Italian healthcare come from the Istat's Report on Fair and Sustainable Wellbeing (Bes). Waiting lists remain the number one enemy and it is no coincidence that the government is working on a plan to be presented in the next few days.

ISTAT provides a good snapshot of the situation, listing the numbers of this alarming situation: "The proportion of people who had to go without treatment amounts to 7.6% of the entire population in 2023, up from 7.0% the previous year. The 372 thousand more people add up to a contingent of about 4.5 million citizens who have had to forego examinations or assessments due to economic problems, waiting lists or difficulties in accessing them," the Bes Report explains. "This increase," continues ISTAT, "can be attributed to direct and indirect consequences of the pandemic shock, such as the recovery of deferred waiting list services for COVID-19 or the difficulty of effectively reorganising health care, given the constraints of covering the increased demand for services with an adequate number of professional resources and, last but not least, the inflationary thrust of the economic situation, which has worsened the faculty of access to health services. In short, the phenomenon of people giving up treatment, due to economic problems and long waiting lists, remains dramatic, and what is more, it is also worsening. As mentioned above, there has been a doubling of the share of those who have given up due to waiting list problems (from 2.8% in 2019 to 4.5% in 2023), while the number giving up for economic reasons remains stable (from 4.3% in 2019 to 4.2% in 2023), but is still on the rise compared to 2022 (+1.3 percentage points in just one year).

Among other things, another worrying element is the fact that the share of health care churn increases as age increases and thus precisely when there is the greatest need for access to health services. In 2023, starting from the 1.3% recorded among children up to 13 years of age, the quota shows a peak in adulthood among 55-59 year olds, where it reaches 11.1%, to remain high among the elderly aged 75 and over (9.8%): in practice one out of every 10 over 55s renounces treatment. The well-known gender differences are then confirmed: the rate of renunciation is 9.0% among women and 6.2% among men, "with a gap that has widened further in the last year due to the increase recorded among adult women", ISTAT further reports. In terms of territory, the increase in 2023 compared to the previous year is concentrated mainly in the Centre and the South: the former has the highest drop-out rate (8.8%), followed by the South with 7.7%, while the North with 7.1% maintains the same level as in 2022. Few regions, however, return to lower levels in 2023 than in 2019. In particular, Sardinia, with the highest churn rates already in 2019 (11.7%), continues to increase them (13.7% in 2023). Among the regions of the Centre, apart from Tuscany, which returns to the value of 2019, Lazio reaches 10.5% (it was 6.9% in 2022 and 7.6% in 2019) and Marches 9.7% (it was around 7% in both 2022 and 2019). In the North, the highest churn rate is recorded in Piedmont with 8.8%, followed by Liguria, with 7.8% (both regions increase by 3 points compared to 2019).

"In this survey," points out Filippo Anelli president of the National Federation of Medical Associations (Fnomceo), "the main responsibility is given to waiting lists. The reflection is that, if we want to maintain this National Health Service, today increasingly at risk, we need to take action, bearing in mind that we are faced with an organisational problem aggravated by staff shortages. Today, therefore, extraordinary intervention concerning operators is unavoidable. Some issues can be resolved, without resorting to foreign doctors, with: the use of the 50,000 specialising doctors, who are graduates and can practise; then we have the possibility of extending the free profession, eliminating a series of constraints, to the white coats who work in the SSN and allowing them to make themselves available to the health agencies, in very specific terms, to provide answers to waiting lists without citizens paying'. The government, however, is ready for a new intervention precisely on waiting lists. Already at the end of the month, a possible law decree is expected with a dowry of 500-600 million to be allocated precisely to the reduction of waiting times for treatment. The measures also include greater control of inappropriate prescriptions made by doctors that contribute to flooding the SSN, as well as funds for extra work by staff and for the use of accredited private facilities.