Indiscriminate cuts threaten Italy's healthcare successes

When an inter-city bus smashed into Giovannina Caprara's car five years ago, she was fortunate to be admitted to coma rehabilitation clinic Istituto Sant'Anna, a rare world class medical institution in one of Europe's poorest regions. In future, others may not be so lucky. Despite its excellence, Sant'Anna is struggling to maintain its services because of Italy's decision to handle its public finance problems with indiscriminate, "linear" spending cuts that are being imposed across the board regardless of the quality of its medical care. Giovannina, 49, is cared for at home by her daughter Maria Teresa and husband Domenico, while doctors supervise from Sant'Anna 40 miles away. The home-monitoring system has so far not been touched by the cuts. But clinic managers say there are fewer funds for the sort of research that bred the technology. "We've been very lucky, the clinic has been wonderful," Maria Teresa, 30, told Reuters during a recent visit. Under pressure to curb the euro zone's second-largest public debt, successive Italian governments have slashed funding for regions by 10 billion euros in the last five years. Regional authorities in turn have targeted the largest item on their own budget: health spending.

In Calabria, where Sant'Anna is located, the health service deficit has fallen to 40 million euros from 250 million euros since 2009. Because cuts are politically difficult, they have hit all of Calabria's hospitals in the same way, regardless of medical or economic performance. That means the Sant'Anna - whose success rate in reawakening people from comas is nearly 20 percent higher than the Italian average - faces similar cuts to those in any other hospital in the region. The clinic has cut 20 percent of its staff, mainly reducing the number of nurses, says founder Giovanni Pugliese. "The government says we are an example for the country, but we are hit by incredible cuts," he says. Italy's approach reflects the political challenges that Rome, like other European capitals, face chipping away at the continent's welfare state. Europeans consider state-funded universal healthcare one of their most treasured rights. Yet countries have overspent, and many are now embarking on painful belt-tightening. Italy's previous government in 2013 recruited a top International Monetary Fund official to identify targeted cuts across Italy's public administration to reward best practice. The effort stumbled and Carlo Cottarelli returned to the IMF.

"If everyone gets cut by 10 percent then everyone grumbles but you meet less resistance than if you say this precise department is badly run or superfluous and needs to close," says Francesco Giavazzi, an economist who has also advised a former government on spending cuts. The drive to cut costs on healthcare, where Italy spends more of its budget than on any other sector excluding pensions, began more than a decade ago. Between 2000 and 2010, it cut the number of hospital beds per inhabitant more than any other country in the euro zone, except for Ireland, according to official European Union figures. Since 2010, the Italian government has also required people to pay a growing proportion of their medical services and medicines directly. With less public investment, waiting lists for operations and other services have lengthened for those who can't afford to go private. At San Camillo hospital in Rome, one of the capital's largest, the lack of space is so acute that patients can remain for days on makeshift beds in the corridors. Examples of what Italians call "malasanita" - or inefficiency, corruption or medical error - often hit the news. Last month the finance police in Reggio Calabria, not far from Sant'Anna, said they believed fraud was behind the case of a fully-equipped heart disease centre completed in 2011 at a cost of 40 million euros which has never treated a patient because the Calabrian government can't afford to hire any doctors.

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Italy anti-immigrant Northern League rallies against Renzi

Thousands of supporters of Italy's anti-euro Northern League filled one of the biggest squares in Rome on Saturday, accusing the government of Prime Minister Matteo Renzi of selling the country out to faceless powers in Brussels. Northern League leader Matteo Salvini, who called the rally, took aim at a series of targets, ranging from illegal immigrants and Romanian truck drivers to tax authorities, banks and big business. "The problem isn't Renzi, Renzi is a pawn, Renzi is a dumb slave, at the disposal of some nameless person who wants to control all our lives from Brussels," he told the rally at the Piazza del Popolo, called just over two months ahead of regional elections in May. Italy's centre-right opposition has been in disarray for the past year, riven by faction-fighting and unable to mount a consistent challenge to Renzi, who’s centre-left Democratic Party holds a commanding lead in opinion polls.

However, 41 year-old Salvini has overseen a resurgence of his party since taking over as leader a little over a year ago, focusing on attacking immigration and the euro in a drive to broaden its appeal beyond its base in northern Italy. Bluntly, even crudely spoken at times, he has articulated a growing frustration at austerity policies many in Italy believe have been dictated by Brussels at the expense of ordinary citizens struggling in the long economic slump. "Europe is what's allowing our truck drivers to be squeezed out by Romanian contracts, Romanian wages and pensions that can be used to come and work in Italy because that's what Europe wants - a race to the bottom," he told supporters who also heard a message of support read out from Marine Le Pen, leader of France's far-right National Front.

With 78-year-old former Prime Minister Silvio Berlusconi struggling to hold his squabbling Forza Italia party together, Salvini has taken over his mantle as the highest profile leader on the right. He is more popular than any political leader apart from Renzi himself and opinion polls show the League challenging or even surpassing Forza Italia as the largest party of the right. As well as immigrants and the EU, his attacks have also been directed against Italy's business establishment, ranging from the head of Fiat Chrysler, Sergio Marchionne to employers lobby group Confindustria and business daily Il Sole 24 Ore. "Italy isn't Marchionne and it isn't Renzi. Italy is millions of tradesmen and small businessmen," he said.

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Italy, Pope voice support in meetings with PM Barzani

A high-level Kurdish delegation led by Prime Minister Nechirvan Barzani is in Rome today, where both governments have pledged to continue their fight against “terrorism” and expand diplomatic relations, a Kurdish government spokesman said. Safeen Dizayee, spokesman of the Kurdistan Regional Government (KRG), said that Italy has stressed its commitment to Erbil in its fight against the Islamic State (ISIS). He added that, in a meeting with officials that included Prime Minister Matteo Renzi, both sides proposed the expansion of their trade mission in Erbil into a full consulate.

Following a meeting with his Italian counterpart, Prime Minister Barzani also met with Pope Francis at the Vatican, where they discussed the situation of more than 1.4 million refugees in the Kurdistan Region, many of them Christians from Mosul and the rest of Iraq. Barzani said that Pope Francis has a deep understanding of the situation in Iraq and of refugees made homeless by the ISIS war, adding that the pontiff had expressed the Vatican’s support for the Kurdish government.

“He said he was grateful for all the support the people of Kurdistan have provided to the Christians, Yezidis, Arabs and all refugees,” Barzani told Rudaw in Rome. Currently 50 Italian military advisors are in the Kurdistan Region, training Peshmerga forces on new tactics of war and anti-tank guns provided by the Italian military. Italian PM Renzi was among the first European leaders to visit Erbil last August, shortly after the Kurdistan Region went into battle against ISIS on its borders.