The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy

Abstract

In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years. In December 2014, there were 59,324 practicing dentists with a ratio of one dentist every 1025 inhabitants, about 90,000 dental chair-side assistants, about 26,000 dental technicians and about 4000 dental hygienists. To enrol in an Italian dental school a student must pass a competitive national entrance examination after obtaining a high school leaving certificate. For entry in the 2015-2016 cycle, there were 792 places for dentistry. In comparison with dental schools in other EU member states, the number of dental students per school is low with an average of 20 students per year, per school and a range of 10 to 60. The aims of this paper are to give a brief description of the organisation of healthcare in Italy, to outline the system for the provision of oral healthcare in Italy and to explain and discuss the latest changes.

Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

“…In comparison to Japan, the dental expenditure per capita was $203 under public health insurance which covered approximately 70% and it accounted for 6.7% of total medical expenditure [26]. As for Italy, the dental expenditure per capita was nearly 250EUR and the public health care system only provided 5% of oral care [27]. In Australia, the mean total dental expenditure was 702 USD and mean out-of-pocket expenditure was 489 USD [28].…”

Italian Response to Coronavirus Pandemic in Dental Care Access: The DeCADE Study

“…The LEA (legislation on essential levels of care) are guaranteed by the central government and national funds are allocated to the Regions through the National Health Plan. Public healthcare system provides about 5% of oral healthcare services and oral healthcare is guaranteed only for specific populations such as children, vulnerable people both medically compromised and those on low income and individuals who need dental healthcare in some urgent/emergency cases [ 26 ]. It could be stated that Italian dental care is mainly provided under private arrangements.…”

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“…Compared to Japan, dental expenditure per capita was $203 under a public health insurance which covered approximately 70% and it accounted for 6.7% of total medical expenditure [24]. Compared to Italy, dental expenditure per capita was nearly 250EUR and the public health care system only provided 5% of oral care [25]. In Australia, the mean total dental expenditure was $702 and mean out-of-pocket expenditure was $489 [26].…”