The Italian government provides hospital and medical benefits to all its citizens and those living in or visiting the country through Servizio Sanitario Nazionale , the national health plan. Healthcare in Italy is aright, and the government, through the national health plan, has the mandate to design and provide healthcare plans for all people living in Italy. The universal healthcare system covers most of the medical services, and in some instances, individuals may have to pay for extra charges, which are generally affordable. Wealthy people may still opt for private healthcare coverage, which is used in private healthcare facilities. The Italian healthcare system is considered as one of the best healthcare systems in the world. The quality of care in the Italian healthcare system is in its incredibly high life expectancy rates and large elderly population. The paper analyzes the Italian Healthcare system based on factors such as quality of care, costs, access to care, disease management and care for vulnerable groups, among other parameters, while also comparing it to other healthcare systems such as the US healthcare system.
Overview: Facts, Behavior and Lifestyle Factors
The Italian healthcare system belongs in the group of the top ten best healthcare systems in the world. The world health organization ranks the Italian healthcare system as the second-best in the world ( Di Matteo & Barbiero, 2020) . This is rather surprising given the recent situation in which the country was seriously hit by the ongoing COVID-19 pandemic, which claimed about thirty thousand lives in the country ( Armocida et al., 2020) . As of March, Italy was leading in coronavirus cases and deaths and seen as the most hit by the pandemic. But Italy derives its healthcare prowess from its design, structure and quality of care and life. The country has in place a universal healthcare system that is implemented and managed throughout all its twenty regions. Healthcare is indeed a right in Italy, and every citizen or person living in Italy is required to have a healthcare plan ( Morciano&Caredda, 2018) . For visitors, one may not be provided with a residential permit without proof of a healthcare plan or registration.
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The average life expectancy for Italian men is about seventy-nine years and eighty-five years for women. Italy is only third after Spain and Switzerland in this category ( Morciano&Caredda, 2018) . The country has quite a high population of older adults, and this number is expected to increase in the coming years. This is mostly attributed to the universal healthcare coverage and the quality of care. These factors thus rank the country as one of the best in terms of healthcare delivery and services.
Both public and private healthcare facilities provide healthcare in conjunction with the Italian national health plan, ServizioSanitarioNazionale . Healthcare receives the majority of its funding from taxes and consumes about nine percent of the GDP. There is also private medical insurance for private hospitals or healthcare providers. One is thus free to choose which type of healthcare facility to visit. Higher-income earners can opt for private medical insurance, which comes with certain benefits, including timely care. Also, visitors are advised to apply for private medical insurance as they may not be staying for long when they visit, and because public medical insurance may take quite long to register ( Di Matteo &Barbiero, 2020) . It is, however, important to note that no matter the type of healthcare, quality of care is generally similar.
Services Covered in the Universal Insurance Coverage
One unique feature of the Italian healthcare system is its focus on quality and free care for all, especially those who need it the most. Emergency or urgent healthcare services are provided free of charge in Italy regardless of whether one has registered with the national health plan or not. Visitors alike can benefit from this healthcare initiative even if they have not yet registered for their health plans. The universal healthcare coverage for public hospitals and authorized clinics includes services such as general hospital services, which comprise of surgery, test, medication during hospitalization, room and medical care. Other services in public hospitals include pediatrician care, obstetrician care, treatment by general practitioners and treatment by other specialists. Patients can also receive tests and exams such as pas tests, prostate exams, and mammograms free of charge. Other services, including medications bought from pharmacies, are co-shared, which additionally makes it easy to access and receive medication. Those who sign up for private insurance often have to pay more out of their pockets for services that are not covered by the national health plan. The major advantage of private healthcare over public healthcare is the ease of access and the fact that they offer services in a timely manner as compared to public healthcare facilities.
Insurers and Costs
Some of the major players in the healthcare insurance industry in Italy are Allianz, Filo Diretto, Europ Assistance and INA Assitalia. Additionally, each of the twenty regions in Italy is charged with the management of insurance coverage and the distribution of healthcare funds. The costs of healthcare insurance does not vary depending on the insurer but on factors such as the type of insurance, which can be private or public, and the region ( Vecchi et al., 2010) . The costs have, however, been made very affordable, making it possible for everyone to be covered. While private coverage costs significantly higher than public insurance coverage, it is still much lower as compared to the cost of private insurance in other countries, specifically the United States. On average, one would only pay about two hundred and forty US Dollars a year to cover their family. As mentioned above, emergency or urgent cases are basically free of charge, while one may have to pay small extra fees in non-urgent cases. Assisted living facilities are becoming more common in Italy, with the older population growing increasingly. These facilities provide numerous social and cultural functions, amenities and utilities for older people and also provide on-site nursing staff. The average cost for obtaining services from such facilities is one thousand and eight hundred US Dollars per month.
Quality and Access to Care and the impact on vulnerable Populations
The Italian healthcare system receives a lot of credit from its quality of care and the universal provision of care, which ensures everyone is guaranteed access to healthcare. This is not exactly the case, as seen in Italy. A good majority of Italians have public insurance plans. This means that most people are satisfied with the quality of care offered in public hospitals. The quality of care is almost similar as in private healthcare facilities ( Morciano&Caredda, 2018) . Urban areas generally have good hospitals that are evenly distributed to improve the ease of access. Generally, in Italy, about four physicians serve a thousand people ( Morciano&Caredda, 2018) . In rural areas, however, public hospitals are few, and people find it quite challenging to access and receive care. Those in urban areas are better placed to access and receive healthcare as compared to those living in rural areas.
The Italian healthcare system has done well to help vulnerable populations get access to care for free and, in some cases, at affordable prices. Children up to the age of fourteen are covered by public insurance plans and receive free care on hospital visits. Women who require various tests and examinations are able to get them for free or at affordable charges depending on their health plan. Those who require urgent treatment get health services free of charge regardless of their registration status with the national health plan. In general, the universal health coverage and the focus on health by the Italian government have made it possible for all vulnerable populations, including the low-income individuals and families, to receive healthcare services, which has, in turn, resulted in quality living and high life expectancy.
Factors that have influenced the Development and Distribution of Health Services
The Italian healthcare system has its roots in the renaissance era when monks and nuns began providing care to the poor and sick in the community. The current universal healthcare system, however, was put in place in 1978 ( Morciano&Caredda, 2018) . Politics, among other factors, led to its establishment, in the bid to do away with public dissatisfaction with the pre-existing healthcare system. The desire to uplift the living conditions and the quality of life of the people has also inspired the Italian government over the years to make healthcare a priority and a right for all.
Combating Communicable and Non-communicable Diseases
It is expected that a country with such as sound healthcare system in place should be better placed to manage and control infectious diseases such as the current pandemic. Italy is one of the countries that has been heavily affected by the COVID-19 pandemic ( Armocida, 2020) . Italy is better placed to fight such diseases as compared to many other counties all over the world. The effect of the pandemic was relatively high in Italy, especially during March and April, mainly due to other factors other than the health system itself. The Italian health system is well established and quite capable of managing communicable diseases. In the case of COVID-19, for instance, testing and hospitalization services were rendered absolutely free, making it possible to test many and put the disease under control. In contrast to other places, people actually pay to get tested and also pay for the medical services offered to manage the symptoms of the disease.
One of the reasons behind the rise of COVID-19 infections and mortality rates in Italy have been associated with the high elderly populations who are more vulnerable to the disease, and the lack of proper preparation to control the spread of disease by the government ( Metzl et al., 2020) . The strong healthcare system made it possible to carry out tests, confine and treat infected individuals and bring down the number of fatalities. At the moment, the country is able to return to normalcy, thanks to the sound healthcare system, which made it easier to test and treat all people free of charge.
It is easier to criticize the Italian healthcare system from a non-communicable disease management perspective. Those with public insurance find it a challenge getting services for non-communicable diseases and conditions. A person may have to wait at list two months to see a doctor after making an appointment ( Nuti et al., 2012) . In remote places where there are few hospitals or doctors, one may have to wait for almost three months. If one wants a much quicker service, they may have to dig into their own pockets or get private insurance plans and visits private Hospitals that offer instant services. On the bright side, the government, through the national health plan, encourages everyone, including the elderly, to get healthcare assistance and services in order to improve the quality of living. Even if the wait is long, at least one is guaranteed to see a doctor and receive medical services free of charge or at lowered rates.
A Comparison with the United States
The United States has a surprisingly different healthcare system as compared to that of every other developed country. Unlike most other developed countries, in the United States, it is legal for an individual to be uninsured ( Hennes et al., 2015) . Everyone basically has the right to decide whether to be insured or stay uninsured. The insurance industry is also privatized in the US, and the government does not guarantee healthcare to its citizens. Individuals can either buy health insurance covers for an insurer or get insured through their employer. Higher-income earners may qualify for Medicare while low-income earners qualify for Medicaid, both programs of which are funded by the taxes. Being that the insurance industry is privatized, healthcare costs are ridiculously expensive in the US ( Hennes et al., 2015) . The healthcare packages provided through Medicare and Medicaid are cheaper and works, especially for low-income earners and families, but people still get to pay out of their pockets for extra services. While insurance is generally expensive in the US, paying through cash is even more expensive. For instance, treatment costs for COVID-19 in the US may rise to twenty thousand dollars for an uninsured individual.
The healthcare system in the US is much different from that of Italy or almost any other European country. By focusing on COVID-19 alone, one is able to observe this contrast. In Italy, tests and treatments for COVID-19 are free of charge, while people have to pay even to get tested in the US. The lack of access to healthcare and the inability to afford such high medical costs is probably one of the reasons why minority communities are most affected by the pandemic in the US ( Metzl et al., 2020) . This may also suggest why there are far many deaths in the US than any other place in the world with regards to COVID-19. It is perhaps even more surprising that the US spends almost twice than Italy, with respect to their GDP, on healthcare. One would imagine that all that money would be put to good use to establish a better and more comprehensive healthcare system.
Conclusion
The Italian Healthcare system indeed stands out as one of the best throughout the world, and one that almost anyone would love to have in their country. The large elderly population, the high life expectancy rates, affordability and access to care and the quality of care are some of the indices that point to the prowess of the Italian healthcare system. Almost all medical services are covered through the universal health coverage put in place by the national healthcare plan. The free emergency healthcare services show just how much the nation is focused on improving the quality of life. The major issues that can be taken away from the Italian health system include overcrowding and long waits at public hospitals. While Italy is among the countries that have been heavily hit by the pandemic, its free testing and treatment have made it possible to control the spread of the virus and bring about normalcy in the country. In comparison to the United States, the Italian healthcare system stands out, and other countries, including the US, must restructure their healthcare systems to be able to improve health and quality of life, especially among their minority and low-income populations.
References
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