Tag Archives: italy

Health data key focus of AHCJ meeting held in Italy

Fabio Turone

Fabio Turone

FLORENCE, Italy – The Italian chapter of AHCJ actively contributed to the success of a two-day meeting organized by Science Writers in Italy in the wonderful Skeletons’ room of the Museum of Natural History in Florence and in Galileo Galilei’s charming Villa il Gioiello.

Some 35 science and health reporters and editors came from all over Italy on Feb. 15 and 16 to discuss continuing education, the role of international networking and the challenges of making a living as a freelancer. Health data, which has only started becoming available to Italian journalists in recent years, was a key focus of the workshop, and will be the focus of courses for journalists being planned in the coming months, again with the involvement of the Italian chapter of AHCJ.

Dialysis program: Experiment in socialized medicine comes with high costs, risks

ProPublica’s Robin Fields has put together an artful examination of the nation’s Medicare-funded dialysis system. Part history and part investigation, it explains how this massive anomaly of government-run medicine came to be, and how it demonstrates the promise and peril of so-called socialized medicine.

The reporting has had an immediate impact, both upon the dialysis industry (read leaked plans for their response here) and upon the federal government. For health journalists, the federal response is particularly interesting, as it involves the disclosure of previously hidden data, and a classic government excuse.

ProPublica first asked CMS for the clinic-specific outcome data it collects — at taxpayer expense — two years ago under the Freedom of Information Act. The agency declined to say whether it would release the material until last week, as this story neared publication. It subsequently has provided reports for all clinics for 2002 to 2010. ProPublica is reviewing the data and plans to make it available for patients, researchers and the general public.

The reasons CMS has given for withholding the information until now is that some measures are disputed or lack refinement. Regulators and providers can put the data in perspective, officials had said, but patients might misinterpret the information or see it as more than they really want to know.

As befits something destined for publication in The Atlantic, Field’s piece might take more than one sitting to fully digest. And, if you haven’t yet had that second sitting, you’ll have missed some particularly nifty bits of comparative journalism, particularly where Fields compares the U.S. system to that in Italy, where the costs are significantly less and patients “got half the average dose of Epogen given to U.S. patients, perhaps because there’s no profit incentive to give them more.”

In Italy, about one in nine dialysis patients die each year. In the United States, that number is one in five. In dialysis treatment, there’s a trade-off between speed, cost and outcomes. And even high-rated Italy has had to make a few sacrifices, as evidence by comments from an Italian doctor:

“The decision to make dialysis faster wasn’t a scientific decision, it was a managerial decision,” he says. “It’s to allow you to do four shifts a day and make money.” He schedules just two shifts a day to accommodate longer treatment times.

Fields ends the piece on a high note. There’s hope for future efficiency in the dialysis system, thanks to a new program of bundled payments that will supplant the current system in which clinics see the actual dialysis as a “loss leader” and profit instead from heavy use of well-reimbursed drugs.

ProPublica promises more stories about this throughout the week, so be sure to check back its site for developments. Fields discussed dialysis on NPR today, as did Dr. Barry Straube, the chief medical officer at CMS.

The real challenge for Italian health care

Changes are on tap for the Italian health care system. Standard health care costs will be defined, which means determining the amount necessary to keep Italians healthy, starting with what “virtuous regions” spend, (meaning those regions with their balance sheets in order: Emilia-Romagna, Lombardy, Tuscany and Veneto). A saving on standard costs of at least 4 billion euro is expected.

Gianluca Bruttomesso

Gianluca Bruttomesso

Right now, Italy spends less on health care than 15 other European nations, which allocate 9.2 percent of their GDP compared with Italy’s 8.7 percent. This figure is even less than the Organization for Economic Cooperation and Development average (8.9 percent). The Italian public health care system is ranked second worldwide, according to the WHO.

However, AHCJ member Gianluca Bruttomesso raises some questions about why the system should be subjected to limits and  deceleration in development. Read more …

Delivery room fight shows structural problems in Italian health care

Over at BMJ’s Open blog, Fabio Turone explains the systemic issues behind the particularly sensational headline that, as he wrote, “a woman lost her uterus, and her newborn is in a coma because two obstetrician gynaecologists went into a fistfight in the delivery room of a university hospital in Sicily.” Turone is an AHCJ member and founder of Science Writers in Italy.

sicilyPhoto by JohnBurke via Flickr

It’s really a story of two obstetricians and one malfunctioning medical system. Understand those two doctors and you understand a key dilemma in Italian health care.


Obstetrician one is a senior staff doctor, who’s nominally in charge in this situation.

Obstetrician two is a young physician who, for all intents and purposes, works at the hospital as well. He’s being “paid” with a scholarship and isn’t supposed to treat patients, though, like all his peers, he does anyway. To further complicate matters, he’d also entered into a private financial relationship with the woman – something that’s also par for the course in Italy.

In this case the woman paid the doctor privately because this was the only way for her to be sure of being looked after by the same specialist all through the pregnancy, including the delivery, in the public hospital (when a woman is looked after privately by someone working in the hospital, the colleague in charge on the day of delivery usually doesn’t interfere: it’s standard practice, and it is considered fair play).

So, it was a matter of seniority within the hospital running head-on into an outside doctor-patient relationship. Ironically, Turone said, the government had already taken measures to end such fuzzy relationships in 2007 – but then delayed their implementation until 2012.

For more about health journalism in Europe, see AHCJ’s new “Covering Europe” initiative. The effort is coordinated by veteran English health journalist John Lister.