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HEALTH

OPINION: Italian healthcare is stuck in the past – but now it has a chance to modernise

The move to digital prescriptions was one positive to come out of the pandemic in Italy, but this could soon be reversed - despite the urgent need for more reform, says Silvia Marchetti.

OPINION: Italian healthcare is stuck in the past - but now it has a chance to modernise
Paper prescriptions were the only option in Italy until the Covid pandemic. (Photo by Tiziana FABI / AFP)

At the end of 2022, Italy’s government approved a one-year extension of electronic prescription for medicines, but it is just temporary and there’s a high risk it might disappear in 2024.

The e-prescription should be made a permanent measure, alongside other urgent improvements in the Italian healthcare system that’s in need of modernization.

In recent weeks, doctors and patients held their breath as political parties debated the fate of digital prescription slips. Until the very end, it looked like the digital ricetta medica was going to be shelved, reverting in January to the pre-Covid paper slips and the nuisance of going to the doctor to fetch it.

The e-prescription has been one of the few positive outcomes of the pandemic. It proved a godsend for both general practitioners (medici di base) and patients during the Covid emergency, when social distancing was the norm and crowding at the doctor’s office was the best way to pass on bacteria and viruses.

Many Italians turned to the digital ricetta during lockdown, even those who’d normally queue up regularly at the doctor’s just to grab their prescription and go to the pharmacy.

READ ALSO: Five essential facts about Italy’s public healthcare system  

The ricetta elettronica also spares a lot of paper waste and precious time, allowing people to go shopping or to the gym instead of waiting hours in line. It has helped to boost the digitalization of Italian health care.

Before Covid, even patients with chronic diseases who needed a monthly prescription had to knock at their doctors’ door.

If next year there is no radical reform that makes digital ricetta the rule and a structural measure, it would be a major step back. 

Photo by Marco BERTORELLO / AFP

The truth is that not all doctors, nor patients (particularly the elderly), are digital savvy. Many doctors I know still prefer to write by hand the paper prescriptions with their personal signature.

My medico di base really needs to retire. He is 70 and even though patients call him by phone to order prescriptions he is able to send just some ones via email while others for specific medicines they still have to pick up at his office, getting in line as if they had to be visited. It is a major nuisance.

When I was living in Holland back in 2005 doctors were accustomed to sending digital prescriptions straight to the pharmacy nearest to the patient’s home, who just had to stop by after work. 

Patients with chronic diseases would regularly drop by the pharmacy next door and pick up the monthly prescribed dose. I wish it worked the same way in Italy.

READ ALSO: How bad is Italy’s north-south ‘healthcare gap’ really?

There are many other aspects of healthcare that should be modernised permanently in Italy. 

And this can be done by boosting online centralized services, which citizens could have access to through their fascicolo elettronico sanitario (electronic medical file), which is like their ‘health passport’ where all health information should be stored, from prescribed medicines to allergies, hospitalizations and results of exams. 

The fascicolo was launched with Covid to download test results and green passes, but it has enormous potential. It is linked to a personal tessera sanitaria (the health card), otherwise known also as the codice fiscale (tax identification number).

The electronic fascicolo should allow the booking of medical appointments and exams at public and private hospitals, and the ordering of medicines at your pharmacy that do not need a prescription. An SMS could be sent to alert patients when medicines and exam results are ready.

Much-needed healthcare improvements also include more efficient online bookings of doctors’ appointments, check-ups and exams. Many hospitals and clinics have online platforms for private booking, but these seldom work well due to internet glitches so patients have to revert to call centers which are always busy, leave their number and hope to be called back. Online platforms are also useful if one has to cancel an appointment.

READ ALSO: Who can register for national healthcare in Italy?

There should be online tickets for blood tests at medical labs and hospitals, downloadable on smartphones with a precise time. It’s crazy that people need to queue up early in the morning, without breakfast, just to take the bigliettino (ticket with their number) and wait to be called by the nurse for the blood test.

In Italy everyone knows that national healthcare waiting lists for surgeries, exams and day procedures can be months-long, but private facilities, where patients are willing and can afford to pay, cannot be as slow as the public sector. I remember once having to book an emergency private allergy test by phone and finding out I had to wait four months, despite it being at one of the biggest hospitals in Rome. 

Private appointments at public hospitals, which can cost up to €300, need to implement faster appointment procedures and boost the number of available doctors.

Italian public healthcare is one of the most democratic in the world, willing to treat anyone in need for free. But when it comes to modernisation, there are many challenges yet to overcome.

Member comments

  1. My doctor does use electronic prescriptions sent to the pharmacy, but then I need to go to the pharmacy to show my copy so they can order. the medication as the government does not allow them to keep a stock. Admittedly it’s not a standard medication but you would think the pharmacy could place the order without my confirmation .

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TRANSPORT

OPINION: Why are Italians so addicted to cars?

In a country as attached to the car as Italy, what would it take to get more people to use greener transport? Silvia Marchetti looks at what’s behind the country’s high levels of car ownership.

OPINION: Why are Italians so addicted to cars?

Many foreigners I speak to are shocked by the ‘car first’ mentality that rules in Italy, and by Italians’ degree of addiction to any wheeled vehicle. 

There’s practically one car around for each Italian. Between 2010-2020 the population dropped but there were three million more cars on the roads, despite soaring living costs and falling salaries. 

Italy’s rate of car ownership is the second-highest in Europe after tiny Luxembourg. All Italian regions have a lot of cars running but surprisingly, the number of passenger cars which is the highest at EU level can be found in the Alpine regions of Valle D’Aosta and the northern autonomous province of Trento, where particular regional statutes envisage special tax incentives helping locals to buy new cars.

Most Italians just don’t like walking. They aren’t active travelers who’d opt for a bike, and can’t go even 500 meters without a wheeled vehicle, be it a Jeep, motorbike, Vespa or motorino. 

But it’s not really their fault. People in Italy haven’t been educated on eco-friendly modes of transport, simply because infrastructure like bike lanes, pedestrian paths, high-speed trains, efficient trams, subways and buses are rather lacking. And there aren’t many walkable pavements in cities, let alone in old villages. So the car is Italians’ second home. 

READ ALSO: These are the most (and least) eco-friendly towns in Italy

There’s an historical reason for this, too. After the second world war, during the economic boom when Italy finally rose from the ashes of the defeat, owning a cinquecento or maggiolino was a status symbol. In the 1960s my father would squeeze eight friends into his cinquino and drive around all night, sharing the fuel cost. Then the car fad turned into a frenzy, and now it’s an obsession.

Iconic Italian car and motorbike models fuelled a post-war fad – which has become an obsession. (Photo by Vincenzo PINTO / AFP)

Whenever I need to go somewhere far from my house I wish I could do the entire trip by public transport and ditch my car, so as to avoid having parking problems too. I remember once when I was at university there was this huge party near the Colosseum, I drove around for an hour looking for a parking spot and eventually I gave up, went back home really frustrated. 

Car sharing also is something totally foreign to Italians. You just need to look around in the morning at rush hour to see that there’s just one person per car, which is totally unsustainable climate-wise.

READ ALSO: Rome ‘among worst cities in Europe’ for road safety, traffic and pollution

Even in areas like Milan, where public transport is more efficient than in the southern regions, people still stick to their car or motorino which just proves how it’s a matter of mentality rather than of transport provision. 

On the other hand, if I want to visit Tuscany or Umbria from my house in Rome’s northern countryside, there aren’t even any direct connections.

My Italian millennial friends refuse to take a bus or tram to the gelateria a few blocks away from their home – the car is the rule, and they don’t care if they risk a fine for double parking, or parking in front of a building entrance. Forget walking, it just isn’t ‘done’.

Italy will soon invest some €600 million in projects aimed at improving bike and pedestrian lanes under initiatives funded by the PNRR, but the mindset of drivers must also modernize for all this money to be really effective. 

OPINION: Why cycling in Rome isn’t as crazy as it sounds

Italy needs an information campaign to raise awareness of environmental and health issues, and this must start inside schools and continue in college. Families also should educate kids to healthier transport modes, and stop buying those ‘micro cars’ when they’re 13 which don’t require a driver’s license. 

I often ask myself what it would take to get Italians – but also other nationalities – out of their cars, or off their noisy motorino with illegal upgrades that make a hell of a noise. Rising oil prices haven’t done the miracle in making car ownership unaffordable. 

Hiking car prices would kill the industry, so the only way is to give tax breaks or incentives to families who keep just one car and manage to share it, or raise taxes if each family member has one. 

Perhaps in a very remote future, interconnected green transport from the doorstep to the destination might be the solution, but at the moment that’s science fiction.

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