The Impact of Market Thinking and Italian Culture on National Health Service : Descriptive and Philosophical Aspects

Abstract

The article analyses the new problems coming out in the Italian health care system, a particular sector of social policies. The literature and the national debate lead to a both descriptive and theoretical reflections about the health policies aims, in order to understand the implications of the impact of market thinking on social justice and effects on fundamental values like solidarity and reciprocity. The health problems about the relationship between state and market concerns not only the economical, political and social consequences, but also the ethical ones concerning equity conditions of the Italian National Health Service. Indeed, the main health issues are: the problem of waiting lists and the freedom of choice for patients-customers; the relationship between medical doctors and patients and the implications from a professional ethics point of view; the impact of legal regulations and market initiatives introduced by the European Commission for pragmatic reasons (cost control) etc. Studying the evolution oh health policy in Italy, within the framework of the dominant solidarity model of the Italian welfare system, we analyse the new equilibrium between the State and the market in delivering health care services. It concerns the role of government and the private sector, their aims of providing better ways of health care, in order to address the issues of the effect of market thinking and its impact on equitable access to health care, system efficiency, outcome for both individual and population, and on the doctor-patient relationship. We also examine the systems of health care funding (i.e.: who is paying? public, private insurance, other private funds, out of pocket payments), with implication for equity and efficiency. We focus our attention on the large request of health goods and services, that represents a big challenge for the recent economic and social situation, with limited resources and necessity to change its redistributive criteria. This has implications for questions dealing with territorial solidarity, with special reference to the Northern/Southern divide. Moreover, we look at attitudes and opinions expressed by Italian people on their level of satisfaction with the INHS. This has implications not just on health financing, but also on preference for a public or a private system (exit/voice/loyalty to use Hirschman's terminology). In this way, we try to examine some issues like: a) levels of satisfaction between public and private health: both similarities and differences in the regions; b) freedom of choice; c) no to public health in the hands of the private sector: the verdict of the electorate; d) differing attitude of the people towards the public and private sector etc. Finally, we debate how in western countries the concepts of needs and right to health change of meanings and this imposes a ri-definition of the notion of health citizenship, strictly connected with welfare and market.