Health care expert compares Italian health care system with U.S.

President Barack Obama’s plan to reform health care bears many similarities to the system used in Italy, where citizens have a constitutional guarantee to free medical care.

Amleto Cattarin, a lecturer from the University of Padua, Italy, says Italians have the option of visiting a public hospital – generally owned by health care units and sometimes established as an autonomous trust — for free care, or visiting a private practitioner or clinic, which, like the United States, comes with a cost which is reimbursed by the health care unit of the state where the person resides.

“At the same time, if we pay an insurance policy to be able to have the treatments and the therapies, the care of a specialized private clinic or private practitioner, we can deduct part of that sum – corresponding to the premium paid for possible permanent disability – from our salary and wages,” says Cattarin, who presented “The Italian Health Care System — Lessons for the U.S.?” at the Wake Forest University School of Law. The lecture was held Friday, Sept. 11, in the Worrell Professional Center.

“We have a quite good health care system,” said Cattarin, who teaches Public Comparative Law and Constitutional Law at the Padua School of Law.

Health care is everything, you realize how fine and how good you feel when you can turn the life of someone from the dark side to the light

An attorney, Cattarin is the director of the legal department of two Local Healthcare Agencies in Veneto, Italy, which have health care jurisdiction over 650,000 people and have about 4,500 employees, including six hospitals.

“Health care is everything,” he said. “You realize how fine and how good you feel when you can turn the life of someone from the dark side to the light … I’m enriching myself as a person, but also as a lawyer.”

Obama says his plan would, for example, assure affordable coverage for all Americans, as well as reduce long-term growth of health care costs for businesses and government, protect families from bankruptcy or debt because of health-care costs, guarantee choice of doctors and health plans, allow people to maintain coverage when they change or lose jobs, and end barriers to coverage for people with pre-existing medical conditions.

The issue has been surrounded by controversy since Obama announced his plans to reform health care during the presidential campaign. People against universal health care have voiced their concerns – sometimes loudly – during a series of town hall-style debates held by lawmakers. Several ideas and plans have come of out Congress, including a proposal by Senate Finance Committee Chairman Max Baucus (D-Mont.) on Sept. 16. The Baucus plan carries a price tag of $856 billion over 10 years and calls for sweeping insurance market reforms and payment system changes, as well as requirements for all citizens and legal residents to buy insurance, according to published reports.

Italy, which has a population of about 60 million, spends $140 billion annually on health care. The United States, with more than 308 million people, according to the latest data, is expected to spend $2.5 trillion in 2009 on health care, according to Cattarin.

Cattarin says he earns about $85,000 per year, and about 30 percent goes to taxes, about $5,000 specifically for health care.

“If we have a high public debt, it’s not due to the fact that we provide free medical care.”

The Italian system is based on national model but is governed regionally through 22 managing agencies and about 150 hospitals. The Veneto region, which Cattarin helps to oversee, has 1,076 medical specialists, 1,307 pharmacies and about 3,600 general practitioners, who are among 15,000 to 20,000 in the nation earning about $80,000 per year. Patients, with the exception of emergencies, are treated according to the severity of their condition, with waiting times range from 10 days to a year. Italian citizens who use the system have a regular family doctor, who provides free treatment. If referred to a specialist, patients pay a maximum fee of about $50, Cattarin says. Patients sent to hospitals pay nothing.

“We don’t need to be citizens in Italy to get health care,” says Cattarin, who went on to explain that non-citizens also are entitled to free health care in any Italian hospital. People can seek care outside their region, but their home provider must reimburse the hospital or clinic in which they are treated.

“Anyone, regardless of his position and his salary or wages, is entitled to get free medical care.”

The Italian system, which had a system similar to the United States until 1978, balances individual rights against the collective interest, as laid out in the 1948 constitution. People who refuse medical care, for whatever reason, may find themselves before a judge, who will decide whether the public would be better served if the patient were treated.

Cattarin told the story of an 87-year-old woman who had developed gangrene in one of her feet. She refused treatment, which was amputation. “I have got to the age of 87,” she said, “and I want to die with my two feet.”

“No one can be obliged to undergo any treatment, except under the provision of the law. If we are afraid of the fact that an infection can spread, in a population, in a society, in a community, we can force, but just under the provision of the law, someone to get medical treatment. There is a limit, although, to this; it is the law may not violate the limits imposed by the respect for the human being.”

Angelo Malvestio and Licia Memo are Italian exchange students visiting the Wake Forest law school for the fall semester. The pair, who attend the University of Padua, are happy with the Italian system, which, they say, focuses on preventative care. Memo says the U.S. tends to focus more on treatment, as opposed to offering people regular care aimed at preventing disease and preventable medical conditions.

“With Obama,” said Malvestio, “I think the (health care) situation in the U.S. is going to improve.”

Law Professor Chris Coughlin, who teachers bioethics and health care-related courses, said Professor Cattarin’s lecture about the Italian healthcare system was quite informative and timely.

“We can learn much here in the United States by examining health care systems like Italy’s,” she said. “For example, Italy’s health care system was ranked second out of 191 countries by the World Health Organization’s listing of top countries for quality healthcare. In contrast, the United States was ranked 37th, the lowest of any industrialized nation.”