Healthcare, 24 million chronically ill people in Italy: 60% resort to private visits, 30% forego treatment

More than a third of Italy with the right to health 'suspended': these are the 24 million chronic patients, destined to become 25 million by 2028, who, amidst biblical delays in recognising their illness, waiting lists, territorial inequalities, therapies paid for out of their own pockets and a 30% dropout rate, live a personal odyssey on a daily basis. While the flagship measures approved over the years in their favour remain a dead letter. The picture outlined by Cittadinanzattiva's 22nd Report on chronic illness policies, not by chance entitled "Rights suspended", does not make any concessions: the chronically ill - and the rare ones also looked at in the survey conducted among 102 presidents of patient associations and 3,500 patients and caregivers - despite representing a human tide destined to rise over the years with the ageing of the population, still remain out of the spotlight. "Our report denounces the need for effective public policies and the urgency of a renewed pact between the institutions, especially in the relationship between the State and the Regions, to speed up the time it takes for rights to be demanded and implemented fairly for all the country's patients," says Cittadinanzattiva Secretary General Anna Lisa Mandorino. Just look at the National Chronicity Plan (NCP), the 'closest' planning document: the 2016 version has in fact never been implemented due to the original sin of the absence of dedicated resources as well as of monitoring mechanisms. What is worse is that the new NPC, which has been at a standstill for months in the replay between the Ministry of Health and the Regions, despite having included three new pathologies - obesity, endometriosis and epilepsy - replicates the same dramatic absence of funds and evaluation criteria.

In the meantime, the numbers describe the emergency: 40.5% of the Italian population is chronically ill, while those with at least two illnesses number 12.2 million. The over 75s with a chronic disease are 85% and 64.3% have two or more. Rare diseases: according to the Istituto Superiore di Sanità (Higher Institute of Health), about 19,000 new cases are reported every year and 20% of the pathologies concern children under 14 years of age.

On all these people weighs first of all the endless time elapsed before a diagnosis, more than ten years in 27.6% of cases and between two and ten years in 22.9%. Delays that not only postpone treatment but also the financial relief granted by the exemption from co-payment. Only 18.1% were diagnosed in less than six months. The 'reasons' for the delay? 80.2% of those surveyed by Cittadinanzattiva attribute it to the lack of knowledge of the disease on the part of family doctors and paediatricians - who continue to be the point of reference for almost eight out of ten people - 68.9% to the underestimation of symptoms, 46.2% to the patient's lack of listening, 42.5% to the lack of specialised personnel in the area, and 23.6% to waiting lists.

Lists that become a critical node when the course of treatment begins: the greatest hindrances are already encountered in the first specialist visits (64.6%), then in check-ups (56.1%) and in diagnostic examinations (53%). Critical is the recognition of civil invalidity, which accumulates 60 per cent of the reports, while the certification of disability comes close to 40 per cent. Also greatly absent is the appropriateness of patient care, with 70 per cent of reports on the lack of coordination between primary and specialist care, 48 per cent on the lack of continuity of care, 44.3 per cent again on waiting lists, and 43.4 per cent on the problematic integration between clinical and social-welfare aspects.

59.8% of citizens make use of private or intramural examinations; 52.8% buy necessary drugs that are not reimbursed by the SSN; 50% carry out diagnostic examinations in private or intramoenia; 47.5% buy parapharmaceuticals such as food supplements, dermo-cosmetics, ointments. 42.4% spend privately for tertiary prevention (diets, physical activity, devices); 36.3% for primary and secondary prevention; 22% for psychological support; 16.9% for travel due to treatment; 14.7% for specialist visits or rehabilitation activities to be carried out at home; and 12% for the purchase of prostheses and aids that are not recognised (or insufficient in quantity/quality). "Over 30% of patients - Cittadinanzattiva warns - inform us that they had to give up treatment. In 19% of cases it happened sporadically but for over 12% it happened often".