The Comparison of Health Status and Health Care Services in Italy and the United States

One of the most important things in life is health. People spend much time and effort to stay healthy. Governments spend billions of dollars on health care programs. All these is done with one purpose to preserve people’s health. However, different countries have different regulations and health care systems.

The aim of this paper is to compare health care systems in the USA and Italy. The paper will provide detailed information regarding the demographic situation in both countries, the amount of expenditure on health care system, and macroenvironmental influences on the systems in both countries. This paper also demonstrates that the expenditure on health care system does not reflect the quality of services and does not mean better or longer life.

Population and Health Status

Demographic Characteristics of Italian Population

The number of Italian population reached 60.2 million people, as estimated on January 1, 2013 (OECD, 2016f). Italy occupies the twenty-third place in the world and the fourth in the European Union by population. The density of the population is 201 inhabitants per one square kilometer. However, the population’s distribution is unsmooth. Po Valley, Rome, and Naples are the most densely populated places, while such areas as the Alps, Basilicata, the Apennines, and Sardinia are the sparsest regions.

On January 1, 2014, the number of young population (0-14 years ) in Italy reached 13.9%, the working age population (15-65 years old) reached 64.7%, and the inhabitants over 65 years old counted for 27.8% (OECD, 2016f).

General median age in Italy is 44.8 years; among men this number is 43.7 years, and among women 45.9 years. This means that half of the Italian men today are 43.7 years old or more and half of the woman 45.9 years old or more (OECD, 2016f).

Mortality in Italy

Life expectancy at birth is one of the most widely used factors for analyzing mortality. It is an average number of years a person can expect to live when exposed to current mortality condition thought his or her whole life. This is a very simple but, at the same time, very powerful tool used to demonstrate trends in mortality.

Life expectancy in Italy has increased over the last years. It has happened due to the economic development, improvement of the environment, healthy lifestyle, achievements in medicine, and reduced infant mortality rate. Life expectancy in 2013 was 82.8 (OECD, 2015a).

Infant mortality rate, which refers to the death of children under 12 months of age, was indicated at 2.9 deaths per 1000 birth in 2012 (Infant mortality rates, 2016). This indicator did not change from the previous year.

Causes of Death

There were 613, 520 deaths estimated in Italy in 2012(ISTAT, 2014). The age-adjusted rate was estimated at 92.2 per 10 000 inhabitants. Age-adjusted death rates show what the mortality level would be if changes in age composition of the population did not occur from year to year. It shows the decline in the rate between the years 2007 and 2012 by 6%. At the same time, the deaths number increased by 7% due to the process of population aging (ISTAT, 2014)

Ischemic heart diseases (75,098 deaths), cerebrovascular diseases (61,255 deaths), and other heart diseases (48,384) were top three causes of death, which accounted for 30% (ISTAT, 2014).

The Quality of Life in Italy

The economic situation has improved at the end of 2014 and during the first months of 2015. The change started in the North of the country and then spread to the rest of it effecting every household.

People’s income and purchasing power increased by 0.7% in 2013 and 0.1% in 2014 (ISTAT, 2015). However, the final consumption spending grew too slowly because of the fact that people’s desire to save money slightly increased.

The trend of growing absolute poverty stopped at 6.8% in 2014, as compared to 7.3% in 2013. There has also been a trend of decreasing severe deprivation for the last two years. As of now 11.2% of people are living in families with severe deprivation. In addition, the number of people, who indicated that getting to the end of the month is extremely difficult, slightly improved. It is at 17.9% as compared to the maximum number of the decade registered in 2013 at 18.8%) (ISTAT, 2015).

The index of income inequality was improving gradually up till 2008. This was possible due to the reduction of inequality and increase of income. However, since 2008, the composite index was decreasing; the situation changed in 2014 with the increase of the index by 0.2 points (ISTAT, 2015).

Demographic Characteristic of the American Society

The population of the United States of America was estimated at 316.5 million people in 2016 (OECD, 2016f). This makes the country the third most populated in the world. The densest populated state is the DC, with the population density of 10994 people per one square mile (CENSUS, 2016).

The age structure of the American society is fairly diverse with 19.8% of the young, 66.8% between ages of 15 and 65, and 13.4% of people at the age of 65 and more (OECD, 2016f).

Mortality and the Causes of Death in the US

Life expectancy at birth for both sexes reached 78.8 years in 2013 (OECD, 2015a)

Infant mortality rate has slightly improved in 2012 in comparison to 2011. The infant mortality rate in 2012 was 6 per 1000 births in comparison to 6.1 in 2011 (OECD, 2016c).

2 543 279 deaths were registered in the United States. This number is 27 821 deaths larger than in 2011.  The estimated age-standardized rate was 732.8 deaths per 100 000 of standard population (CDC, 2015a)

In 2012 the fifteen main causes of death accounted for 79.4% of deaths (CDC, 2015b). The ranking of the main causes of death included heart disease, cancer, chronic lower respiratory diseases, stroke, accidents, Alzheimer’s disease, diabetes, pneumonia, kidney disease, suicide, septicemia, chronic liver disease, hypertension, Parkinson’s disease, pneumonitis due to inhalation of solids and liquids.

The Quality of Life

The material living conditions in the USA are higher than average in the countries of the OECD. Net house adjusted disposable income and household financial wealth are higher than the OECD average. They are $39 277 in comparison to average $27410 and $161 647 as compared to the average $81 472 respectively (OECD, 2016b). Americans also have better housing conditions than the average OECD inhabitant does. However, there are differences in life conditions among the citizens of different regions in the USA. For instance, the average adjusted disposable income of a household in DC is two times higher than that of Idaho. Unemployment rates are also very different. They vary from 2.9% in North Dakota to 7.8% in Rhode Island. (OECD, 2016b).

Availability of Health Services

Basic Organization of Healthcare Services in Italy

Health care system in Italy is based regionally and is available for all citizens and foreign residents that legally stay in the country. The system is universal and automatic, which means that every resident can go to any public hospital and does not have to worry about insurance. Italian healthcare system has three levels: national, regional, and local. The national level takes care of the general objectives and basic principles of the national healthcare system. Regional governments, with the help of regional health departments, ensure that the benefits package is delivered through public and private hospitals.

Healthcare providers in Italy are private and public. Public providers of health are either independent or under control of their local health authority. However, even though they are independent they are still under regional planning, financial, and control scheme. Private healthcare providers, on the other hand, cooperate with local health authorities and regional authorities to ensure the supply of services.

Every legal resident of Italy can access healthcare services without much trouble. Almost every household has their own family doctor and if needed they can schedule an appointment. If a person needs to visit a specialist, the situation is a little more complicated. There two options available. Firstly, a patient can go to a public hospital, schedule an appointment, and wait for it. The second option is a private consultation, where a patient has to pay a fee to get a consultation quicker.

Utilization of Services

Different factors may cause utilization of healthcare services. They include aging of the population as more diseases will be associated with aging, and more deaths will occur; technological development, including new tools and devices, that this will cause the old ones to become outdated; increased health insurance, as well as new diseases. In addition, the availability of the services affects their utilization.

For example, hospital supply is important. The total number of beds in 2012 was 203 723, in comparison to 208 854 in 2011 and 215 980 in 2010 (OECD, 2015c). The trend here is clearly decreasing.

General Description of the US Healthcare System

The USA has a unique system of healthcare services delivery. The system is more privatized than in most European countries, with most of health insurance provided by private insurance companies. Laws and regulations regarding private health insurance are different in every state.

Public purchasers include federal and state agencies. Medicaid is the largest public healthcare purchaser. They provide coverage for people over 65 and people with special needs. State governments, using the funds from the federal government, purchase healthcare services through Medicaid.

Private individuals also purchase healthcare. The majority of the Americans with private insurance purchase it through their employers.

The healthcare providers in the USA are the same as in all developed countries. There is hospital, physician, dental, prescription drug, home health, and long-term care, as well as mental health, public health, and other professional services.

Access to Healthcare Services

Individuals who have insurance can enter healthcare system through a primary care provider. However, with Preferred Provider Organization (PPO) kind of insurance people may go directly to a specialist. Citizens without insurance usually do not have regular primary care provider. Instead, they visit community health centers that provide primary care for uninsured, minorities, and people with low income.

Utilization of Services in the USA

The utilization of the services in the US has the same reasons as in Italy. The trend in the utilization of hospital supplies is the same as well. The number of beds is decreasing. These were 178 869 of them in 2012 in comparison to 182 103 in 2011 and 183 848 in 2010 (OECD, 2015c).

Spending on Healthcare System

Expenditures on Healthcare Services in Italy

The National Health Service in Italy is mainly financed through regional and national taxes. The public system is financed generally through corporate tax, which is united nationally and then redirected back to the regions of origin. Additionally, a part of national value-added tax revenue that is collected by government is distributed to the regions that were not able to amass the necessary sum of money to provide the necessary healthcare level. Regions are also allowed to generate their own additional revenue sources. However, this leads to financial inequalities in healthcare spending among the regions. Local health units are generally financed through capitated budgets.

Private healthcare insurance plays a very small role in Italian healthcare system. Private healthcare usually offers more options to the public, while private healthcare providers provide comfort and privacy in hospitals.

There are two types of private insurance: corporate, when the employer buys insurance for workers and occasionally their families; and non-corporate where the individuals buy insurance for themselves. Both types of insurance are supplied by nonprofit and for-profit organizations.

Data on Healthcare Expenditure in Italy in 2013

In 2013 total healthcare spending accounted for 8.8 % of GDP, what is a little below the OECD average of 8.9% (OECD, 2015b). However, it is important to note that this number decreased over the last years. Between the years 2011 and 2012 this index dropped by 3.5%, and in 2012 and 2013 the number fell again by 3.5% (OECD, 2015b). The recent changes in the health expenditure can be explained by attempts to control the health spending after some regions showed great deficits.

The Italian government financed 77% of total spending on healthcare in 2013,while the average OECD government spending accounted for 73% (OECD, 2015c).

The private spending on healthcare in 2013 reached 22%. This number did not change much over the recent years. However, it remained relatively high in comparison to other European countries, like Germany (14%), United Kingdom (10%), and France (7%) (OECD, 2015e).

In terms of per capita, Italy spent $3077 per one inhabitant, in comparison to the OECD average of $3453 (OECD, 2015e).

Expenditures on Healthcare Services in the USA

Public healthcare is financed through a combination of payroll taxes, premiums, and federal general revenues. Medicaid is a federal-state health insurance program that is administrated by the states. States receive funds from the federal government. The rates vary depending on the states’ per capita income.

Private insurers can be for-profit and nonprofit. State insurance commissioners supervise them by applying state and federal regulations. Private insurances can be bought by individuals, but usually they are funded by voluntary contributors shared by employers and employees.

Data on Healthcare Expenditures in 2013

The USA spends more money on healthcare than any other country. In 2013, they spent 16.4% of their GDP. It is more than the average spending of other OECD countries that show a 8.9% index.  In 2013, the percentage grew by 1.5% (OECD, 2015b).

Government makes up 48% of American healthcare expenditures, which is far below the OECD average of 79% (OECD, 2015f).

Private sources contribute 40%, and people pay the remaining 12% out of their own pocket. Even though the difference between public and private spending is not big, only the minority of Americans has public insurance, while the majority is covered by private insurance (OECD, 2015f).

In the terms of per capita spending, the US spent $8713 per person. This number is much higher than the OECD average of $3453. What is more, the US spent more than any other OECD country (OECD, 2015f).

Macroenvironmental Influences on the Italian Healthcare System

Political Influences on the Italian Healthcare System

The government of Italy is responsible for the distribution of taxes among the regions and does not have a lot of control over the regions. The regional governments have a lot of freedom in choosing the macrostructure of their health system. In addition, they may look for supplementary revenue sources.

Moreover, being a member of the EU Italy has the responsibility to “transport EU regulations into Italian law” (“European Affairs,” n.d.). This means that all laws and regulations accepted by the EU should also be adopted in Italy, with some changes, of course, so they are not contrary to the Italian laws.

Socio-Economic Influences

A number of variables indicate the socioeconomic level of the country. They include unemployment rate, poverty rate, income rate, and inflation rate. All these indexes indicate the population health level and the overall state of the healthcare services.

The unemployment rate is the number of unemployed people divided by the number of people in the civilian labor force. In Italy, this number reached 12.1%. This number was 10.7% in 2012 and 8.4% in 2011. As can be seen, the trend here is the increase in the number of unemployed (OECD, 2016g).

Inflation is the change in the prices of specific products and services that are bought by specific households. The annual growth rate in 2013 accounted for 1.22%. In 2012, this number accounted for 3.04% and in 2011 it was 2.78% (OECD, 2016d). A decreasing trend in inflation can be seen here.

Cultural Influences

The lifestyle choice is one of the cultural factors influencing the health of the nation. The main factors describing lifestyle choices are obese and overweight population, alcohol and cigarettes abusers.

The overweight and obese population are people whose excessive body weight threatens their health. The obese and overweight rate in Italy in 2013 accounted for 45.8% of the population older than fifteen. In 2012 this number was 46% and in 2011 it accounted for 45.8% (OECD, 2016c). The trend here did not change significantly.

Daily smokers are people over fifteen years old who claim to smoke every day. In Italy daily smokers’ rate accounted for 21.1% of the population over the age of fifteen. In 2012 this number was 22.1% and in 2011 the index was 22.5% (OECD, 2016a).

Technological Influences

Technological influences on the healthcare system are enormous. Every new device, tool, and method can change the whole system. At the same time, the lack of some devices or tools can lead to fatal consequences. The availability of different medical equipment is not equal for all countries.

For instance, the linear accelerator was available to 6.16 per million population. To compare, the OECD average was 5.19 per million inhabitants.  The index of availability of radiotherapy units was 6.41 per million people. The OECD average is 5.38 per million population. Therefore, it may be assumed that the situation with main technological devices in Italy is better than in an average OECD country (WHO, 2013).

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