Boom in “private” visits to public hospitals: over one in ten is paid by the citizen

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At least one in ten hospital visits is paid by Italians out of their own pocket, but it becomes over three in ten if only gynecological visits are considered and almost 20% in the case of visits to the cardiologist. Among the tests, however, the electrocardiogram is the one that Italians pay for most frequently in the health service but in terms of incidence it beats all the gynecological ultrasound: over one out of three (36%) is paid by patients. Here are the most striking numbers of the intramural freelance profession or «intramoenia» and that is when the public health system “plays private” within its spaces.

Intramoenia to avoid waiting lists

After Covid, also thanks to the waiting lists that have grown enormously, Italians – at least those who can afford it – return to spending out of their own pockets for treatment in public hospitals, choosing to pay for the freelance services carried out by doctors of the Health Service national with volumes that are greater than those recorded before the pandemic. An absolutely legal and open phenomenon even if there is no shortage of abuses and anomalies as emerges from reading the latest Agenas report on «Alpi» (Intramural freelance professional activity) which reports several local health authorities throughout Italy – with peaks maximum in Campania – where intramoenic activity largely exceeds the institutional one, i.e. the ordinary one which must guarantee the SSN to citizens free of charge. A violation on which the latest maneuver provides for greater controls and which must trigger – as the rules provide – the blocking of intramoenia activity if this exceeds institutional activity.

The boom in requests following the slowdown during Covid

What convinces Italians to return to knocking on the door of intramoenia is the guarantee of having treatment guaranteed in a short time: over half (56%) have a waiting time of less than 10 days, while 30% of bookings are set between 11 and 30/60 days (depending on whether it is a specialist visit or an instrumental service). Finally, only 14% of bookings have to wait beyond 30/60 days. The latter times are the minimum waiting threshold for those who receive NHS services without having to reach into their wallets. As stated in its report, Agenas underlines how «following a strong reduction in volumes» of all services in 2020 «due to the Covid emergency, a clear recovery in services emerges; specifically, in 2019, the services provided in the Alps were 4,765,345 and those in institutional settings were 58,992,277, while in 2022 those provided in the Alps were 4,932,720 and those provided in institutional settings were 59,793,294″. In practice we have returned not only to the pre-Covid levels of 2019 but there has also been a growth in intramoenia care.

The ranking of the most popular visits

In particular, in outpatient specialists, the lion’s share of the services purchased by citizens is made up of specialist visits with over 3.7 million services (78%). On an absolute level, the cardiological examination (588,343) is the one performed most intramoenia, followed by the gynecological examination (476,643), the orthopedic examination (466,466), the electrocardiogram (357,526) and the ophthalmological examination (354,319). In terms of incidence, however, as mentioned, the most popular one is the gynecological examination with 32% of the services in private intramural profession out of the total of these visits arranged by the NHS, followed by the cardiological examination (17%) and the orthopedic examination (12%). As regards examinations, the incidence values ​​are between 1% (CT scan, unilateral mammography, Holter, unilateral breast ultrasound, fundus photography) and 36% for gynecological ultrasound. However, the use of intramoenia for hospitalizations is more limited: here citizens choose to pay for the freelance profession, in particular for hospitalizations related to childbirth.

Intramoenia abuses are also under the spotlight

The Agenas report is also useful for measuring any abuses, i.e. when in the local health authorities more internal activities are carried out than institutional ones (i.e. services guaranteed to citizens free of charge) and it emerges, for example, that in 29 healthcare companies this ceiling is exceeded for gynecological ultrasound, in 12 local health authorities for the gynecological examination in 5 local health authorities for the vascular surgery examination and for the obstetric ultrasound. Finally, on the hospitalization front, Agenas reveals that «for all the DRGs analysed, for which at least one case is detected in which the percentage ratio between the Alps and the institutional one exceeds 100%, a structure from Campania is always present».