Italy’s healthcare system may not be perfect, but the people who live there are some of the healthiest in the world.
Yearly health spending per capita $9,800 $3,385
Life expectancy at birth 78.6 years 84.5 years
Overall health, global rank 35 2
With the future of American healthcare under fierce debate, it’s time to contemplate what can be learned from the Italian experience. The Italian healthcare landscape includes hospitals with older equipment, doctors whose early training relied more on books than learning from patient experience and per capita spending one-third that of the United States.
Americans like to say our medical care is the best in the world, while Italians consider their National Health Service to be at times, a bit dysfunctional. But here are the facts – Italians are much healthier than Americans in terms of everything, from overall health longevity, infant mortality, obesity, cancer, diabetes, suicide, drug overdoses, homicides and disability rates.
How on earth do they do it?
First of all, Italians have universal access to medical care. During the year before the Affordable Care Act kicked in, one in six non-elderly American adults had no medical insurance at all and 44 percent of all Americans were uninsured or underinsured at some point. There were actually U.S. students studying abroad in Italy who were receiving medical coverage for the first time in their lives.
Even in late 2016, the peak of Obamacare’s success, 10.9 percent of Americans had no insurance at all and that rate has since risen to 13.7 percent. In Italy, a National Health System funded by taxes, succeeds in providing everyone with doctors’ visits, medications, testing and hospital care at virtually no out-of-pocket cost.
Even if you venture outside the National Health Service to private doctors and hospitals, Italian healthcare is far less expensive. In the U.S. the largest private facilities can essentially charge whatever they want. There are emergency rooms that demand $2,000 just to walk in the door and drug companies that charge over $800 for two pills to rid your child of pinworms.
In Italy, prices are kept down by hard bargaining – emergency room care is free for serious cases, those deworming pills cost one euro total and even the classiest private hospital is unlikely to run more than €500 a night. Italians, who rarely need to pay more than a few euros for a co-pay, have been shown to be 60 percent more likely than Americans to take their medications as ordered.
Italians’ health also benefits from a more uniform distribution of income and wealth, which has repeatedly been shown to improve health outcomes. In the U.S., the average income of the top 10 percent is 19 times the average income in the bottom 10 percent; in Italy that ratio is closer to 10 to one.
Additionally, Italian labor laws ensure that new parents can take time off to bond with their children without losing their job; sick people do not have to drag themselves back to work prematurely and retirement doesn’t equal poverty. Even educated, insured, well-off Americans are less healthy than their peers in other wealthy nations.
It also seems that the Italian lifestyle does the rest. The Mediterranean diet is believed to be the healthiest in the world – rich in fruits and vegetables, low in animal fats. It is low on snacks and desserts as well, so only 10 percent of Italians are obese, compared with a whopping 38 percent of Americans.
The glass or two a day of wine that many Italians consume is good for the heart, while they avoid alcoholism and hard drugs. They may love zipping around in their cars, but they are still close enough to their roots to consider walking the default way of getting from one place to another. Most take a stroll, ‘passeggiare’ after the evening meal and for many, the largest meal during the day is midday, rather than at night. Close-knit families provide a buffer against social isolation. Okay, too many Italians still smoke; 22 percent of adults, versus 15 percent in the U.S., but nobody’s perfect.