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 64km away. The home-monitoring system has so far not been touched by the cuts. However, 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, said during a recent visit.
Under pressure to curb the eurozone’s second-largest public debt, successive Italian governments have slashed funding for regions by 10 billion euros (US$11 billion) in the previous 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 IMF 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 eurozone, except for Ireland, according to official EU 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 cannot 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 center completed in 2011 at a cost of 40 million euros which has never treated a patient because the Calabrian government cannot afford to hire any doctors.
When he founded Sant’Anna in 1996, Pugliese, 65, lured Giuliano Dolce, one of Italy’s foremost neurologists and an international expert on coma reawakenings, out of retirement.
It was a bold enterprise. Calabria’s quality of healthcare is among the worst in Italy; infant mortality is the highest of the country’s 20 regions. More patients leave Calabria than from any other region to seek treatment elsewhere, according to the health ministry.
The Sant’Anna steadily gained international recognition, however. In the past 18 years it has helped 1,200 people emerge from comas.
“People used to believe a coma patient was completely cut off from the world, but we realized it’s not like that,” says Dolce, who at 86 cuts a striking figure with his white hair and blue eyes.
Sant’Anna’s home-monitoring system uses technology and training of family members to give coma patients the same quality of care at home as they would receive in hospital. It costs the hospital less to oversee a patient remotely than to provide for their board at the clinic.
Giovannina Caprara, in a state that Dolce describes as “unresponsive wakeful system,” sits in a wheelchair in her cottage adorned with pictures of saints, and she sometimes seems to smile and laugh.
Maria Teresa says her mother makes small improvements. She has taken her to mass, into the countryside and to a wedding.
“The doctors stop us building false hopes,” she said, adding: “I have always been happy with anything mum could give me.”
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