Access to primary care in Italy: time for a shake-up?

Abstract

The combination of an aging population, the growing prevalence of patients with chronic conditions and advances in technology arouse renewed interest but also significant challenges for primary care (PC) [1]. Although a variety of definitions exist [2], PC can be considered ‘firstcontact, continuous, comprehensive, and coordinated care’. Thus it is the pivotal level of a health care system, and potentially crucial. Broadly, PC includes a wide range of services such as general practice, home care, prevention, counseling and minor surgery, mid-way between hospital and community care. The next essential levels include secondary care (mainly specialist consultations), tertiary care (for unusual disorders) and emergency care (especially for serious trauma). All these further levels must be integrated with PC to provide rational, consistent care for patients [3]. PC is usually described as basic, first-step care for (1) directing appropriate access to outpatient and inpatient services [4] and (2) improving the consistency and sustainability of non-hospital health care services, often perceived as fragmented, poorly coordinated and centred on health professionals [5]. In particular, access to PC seems to be an important feature in most definitions and is still reported as a key issue in many countries, including Italy according to the latest reform, in 2012 (National Law 189/2012) [6]. This article assesses the ‘state of play’ for access to PC in the Italian National Health Service (INHS). After a general overview of the main features of the Italian primary health care system and of the above law, we present the findings of our survey in three northern regions and discuss them in the light of ambitious expectations raised by political pledges and notions of economic evaluation.