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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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OPINION AND ANALYSIS

OPINION: Family is sacrosanct to us Italians – even if it means you can’t get away

Foreigners living in Italy are often left baffled by how much 'la famiglia' is intrinsic to the Italian way of life. Silvia Marchetti explains why families in Italy "stick together like glue", even if it means your relatives are a constant presence in your life.

Published: 13 September 2024 16:24 CEST
Updated: 16 September 2024 12:17 CEST
OPINION: Family is sacrosanct to us Italians – even if it means you can't get away

Family in Italy is considered the building block of society, and it is sacrosanct.

Most Italians give so much importance to it that it is hard for some to believe. Family is far more important in Italy than in other European and western countries where I have lived such as the Netherlands or Switzerland. 

We tend to stick together like glue. 

Talking to several expat friends of mine, I realise this is something that often baffles many foreigners, who are used to leaving the family ‘nest’ at an early stage in life. And it’s not just an impression outsiders to Italian culture get by attending huge flashy weddings, religious celebrations such as baptisms, and birthdays, where family members come in dozens. 

La famiglia is our daily reality, for better or worse. 

I’ve had a hard time dealing with family myself. When I was a kid, until I started to say basta to my parents, each weekend and festivity was spent at my grandparents or with my cousins, uncles and aunts. We even all went skiing together or holidaying at our beach homes. My father and his brothers had bought attached studios so we could all always be together.

In Italy, no matter how old one gets, parents, siblings, relatives of all degrees and grandparents are always present. And sometimes, I think, they’re even too present and may tend to often ‘intrude’ in one’s private life. 

In Italy extended families are considered a blessing and youths can’t seem to leave their parents home until they’re very, very old (hence the denigratory term of ‘mammoni’, meaning ‘mama’s boy or girl’). 

Up until after the Second World War, when a new child was born, families in rural areas and on small islands would build an annexed dwelling so everyone could stick together in future. 

When I first visited the island of Ponza, off Rome’s coast, it struck me how huge cave labyrinths had been carved from cliffs into several annexed grotto homes for the entire extended family. 

One could think that it all comes down to a matter of religion: as the majority of Italians are Catholic, and also quite religious, the Church preaches the importance of family as both a key spiritual and material entity that accompanies people throughout their entire lives.

But that’s not enough to explain it. 

I believe the importance of family is part of a typical Italian lifestyle and mindset, a belief in certain values that having family is like an investment for the future, a safety net in hard times. 

READ ALSO: Why are Italians both so religious and so superstitious?

This traces its roots back centuries. Even though Italian society has always been officially patriarchal on the outside, with the husband-father who decided over the fate of everyone, in reality it was the woman (wife and mother) the lady of the household. Usually, kids tend to stick around their mums more than their dads. 

Across history, family members have always stood up for each other, both in aristocratic and poor families. 

It is crucial to keep in mind that we are a relatively young nation when compared to France and the UK. Italian national unity was reached only in 1861 and the Republic was created in 1946; up until then, Italy did not exist. 

It was a mosaic of bickering city-states and fiefdoms ruled by powerful aristocratic families who were constantly at war with each other. Family was the seat of power, and affiliation was more than just identity and belonging. It meant survival.

Likewise, peasants could solely rely on their own family members to survive, keep the harvests going and the land fertile. Each newborn was considered additional labour force to add to the family, a pair of ‘extra hands’ (as my granny would say) to plough, feed the animals and run the farm activities. 

When society went from rural to modern, and people started abandoning villages to move to larger towns and abroad, family was still seen as a pillar. Immigrant Italian families that have flourished across the world, building, for instance, ice cream and pizza empires that still survive to this day, are proof. 

“La famiglia è tutto” (family is everything) is my dad’s favourite motto. 

I believe that, no matter how Italian society will evolve in the near future, spending a lot of time with close family and extended family members will still be a common trait of most Italians. It’s innate.

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