The Italian healthcare system
The fourth chapter of the Second Report on Secondo Welfare in Italy is based on the analysis of the current national healthcare system. Italian public healthcare cannot provide all services requested by a new society that is increasingly demanding, because of the social and cultural changes (among which the prolongation of average life time, the diffusion of new chronic pathologies, the increasing number of non-autonomous individuals, the transformation of the family structure) accompanied by an increasing awareness regarding the importance to preserve good health. Furthermore the long-lasting- economic crisis has exacerbated the situation by contributing to the impoverishment of Italian families and by increasing the number of people who fit in the ‘grey slot’ and who do not have the means to access private healthcare. In this context, it is fundamental to start a fruitful collaboration between public and private actors (associations, third sector, for profit institutions..) in order to elaborate and strengthen health sector proposals directed at satisfying citizens’ needs. Among these actors, mutual aid societies (in Italian: Società di Mutuo Soccorso –SMS-) are very important. These organisations cover a fundamental role in the construction of subsidiary welfare thanks to their strong relationship with the territory and their will to create networks and collaborations at a very local level.
A brief overview on mutual healthcare
The chapter provides a brief overview of mutual healthcare by inserting it in the context of national healthcare system. It provides a historical and normative framework, with a particular focus on major legislative evolutions as well as a presentation of SMS’s principles,values and actions. The chapter continues with a thematic section dedicated to current arguments related to SMS, which are:
- The European context, considering the Statute for a European mutual societies promoted by the European Parliament in an own-Initiative Report on the 14th of March 2013;
- The “mutualità mediata” (indirect mutual healthcare), provided by the new legislation of 2012, which aims at keeping small mutual organisations alive thanks to the creation of networks and collaborations with bigger ones;
- Collaboration with the world of social cooperation, through the creation of dedicated funds, common projects and conventions with medical centres and social health centres;
- The integration of Mutuo Soccorso (mutual healthcare) and Credito Cooperativo (cooperative credit) and the birth of new models in which banks of Credito Cooperativo undertake projects of integrated healthcare in collaboration with SMS;
- Projects on dedicated mutual territoriality conducted in collaboration with No-profit foundations,with a particular focus on the recent activity promoted by Fondazione Welfare Ambrosiano;
- The relation with public institutions and regional public bodies, in view of a proper integrated healthcare with the national service, which can guarantee extra-LEA’s performances1.
A detailed study on small mutual aid societies
In the chapter, a space - that will be deepened in future researches - is dedicated to small mutual aid societies that offer social and healthcare assistance at a local level. Their initiatives are considered fundamental for satisfying small communities’ needs where a relevant number of old people is concentrated. The latter category runs major risks of being excluded from healthcare services due to the absence (or distance) of specialized structures and high intensity hospitals.
A very useful instrument for mutual aid societies is the indirect mutuality. This measure - introduced by article 23 and part of the law number 179 which came out on the 18/10/2012 (“Additional measures for the country’s growth”) aims at helping mutual aid societies that do not possess financial, patrimonial and organizational conditions for directly guaranteeing and distributing services. These societies, still remaining autonomous, can decide to opt for a “gestione mediata” (indirect management) (partial or total) of their own activities. Indeed, this kind of management is based on the establishment of an associative relationship between the receiving society (associated society) and another mutual aid society -bigger and more structured- (associative society). Due to this special relationship, partners of the associative society benefit from the other society’s performances” (Fimiv 2015).
Practically speaking, we can observe advantageous examples of mutualità mediata in Region Liguria (between Cesare Pozzo and Mutua Ligure), in Piedmont (where Mutua Pinerolese collaborates with mutual aid societies in Vinovo and Bricherasio and with the Mutua Solidea) and in Lombardy (where Insieme Salute collaborates with Mutua di Mannate e dell’Insubria).
Other examples of small mutual aid societies’ collaboration and networking
Indirect mutuality presents nonetheless some problems. Among these, we find the risk for small societies of loosing their autonomy or their decisional power. Consequently, instead of opting for the indirect mutuality, a number of small mutual aid societies still prefer not to collaborate with bigger societies, but offer other kind of examples of networking. For instance, in Piedmont we find, at a regional level, the Piedmontese Coordination of Mutual Aid Societies -organized in eleven different councils spread all over the territory. Dated back to 1980s, the aim of this Coordination is to gather mutual aid societies in order to introduce them to one another and successively give birth to an interaction.
Piedmontese mutual aid societies’ experiences are numerous, even in the field of integrated health care insurance: from prevention (ophthalmic, cardiovascular) treated by several active mobile units spread on various territories, to clinics destined for specialized visits and home-care assistance.
The project “Prevenzione e Salute a Km. Zero” in Alessandria provides professional doctors to mutual aid societies’ members; these are available for free cardiological check-ups that include electrocardiograms, urologic visits, dermatological visits, visits for diabetic people including glycaemia tests, all thanks to a mobile unit able to move on the territory.
We then have the C.A.S.A. project (Cura Assistenza Solidarietà e Aiuto), where a voluntary nurse freely offers a domiciliar services to members. These include magnetotherapy, BP measurement, hear rate, and glyceamia check-ups.
These services are the result of a virtuous collaboration between mutual aid societies and local voluntary work, where solidarity is more than ever the priority. Indeed, local community is aware that these services are obtainable thanks to the community’s contribution and as soon as a member takes advantage of it, the mutualistic equilibrium would be broken.
Some considerations on small Piedmontese mutual aid societies
In Piedmont there is also the Fondazione Centro per lo studio e la documentazione delle Società di mutuo soccorso,a foundation dedicated to in-depht studies on mutual aid societies born thanks to Region’s efforts. It contributes to keep societies’ solidarity alive and to disseminate their values in today’s culture.
In 2014, in collaboration with the Coordinamento, the Foundation directed a study where both quantitative and qualitative data on Piedmontese SMS were collected. It emerged that SMS are majorly very small (80% of societies counts 175 members while 17% not more than 50 members). Nonetheless, they have an important impact on the territory where they are able to develop precious mutual aid dynamics directed at members who are involved in the identification of needs and solutions. According to Ermanno Sacchetto, president of the Coordinamento: “In historical mutual aid societies members are not only services’ beneficiaries but also voluntary actors in sustaining the activity. This voluntary work should not be seen in its in usual form, but in its effort to sustain activities in favour of the community members.” Other interesting data, concerning monetary social capital, emerge from the study on mutual aid societies and emphasize SMS’s wealth that amounts to 340.0000 euro (considering the 100 SMS that answered the survey). According to Sacchetto, “These data make us reflect since this sum of money could be used in a project that, overall, may involve several mutual aid societies instead of being invested for single small initiatives”, a consideration which highlights the paramount importance of a network work between mutual aid societies and the territory.
1Essential Levels of Healthcare: services that national public healthcare must offer to the citizens, according to the Italian law.
*For this article, we acknowledge the contribution of Ermanno Sacchetto, President of “Coordinamento regionale delle società di mutuo soccorso piemontesi e della Società di Mutuo Soccorso di Pinerolo”, and Stefano Minerdo, head officer of “Fondazione Centro per lo studio e la documentazione delle Società di mutuo soccorso di Torino”.