The debate sparked by the article by Mario Pepe, President of Covip, published in Il Sole 24 Ore on 11 February, highlights a decisive step: supplementary healthcare is no longer a marginal segment of welfare, but a structural component of the system. After years referred to as the ‘Far West’, the government – referring to Article 29 of the decree law implementing the NRP – is finally introducing a supervisory oversight. This is a necessary step. The numbers speak for themselves: between registered funds and unregistered entities, the resources allocated to integrative healthcare are now between EUR 4.5 and 5 billion per year. A critical mass that calls for rules, transparency and accountability.
A strategic theme
The issue, however, is not only ordinal but strategic. We are going through a historical phase in which Europe has chosen to invest in the social economy, endowing itself with a Social Economy Action Plan that Italia has adopted and developed. In this framework, integrative healthcare and mutual aid are not an appendix to the system, but one of the levers through which to redesign welfare, especially in the face of the structural crisis of the National Health Service, the growth of private expenditure and the exponential increase in chronic illness and non-self-sufficiency.
Mutuals at a crossroads
The mutual system is called upon to decide what role it wants to play. It is not a matter of claiming a subjective space, but of clarifying the complementary object: for whom we work and in respect of what needs. Today, the real issue is Long Term Care, the taking care of chronic illness, frailty, and disability. Our SSN, created in 1978, has won the battle of acute care, but has neglected for decades the development of a solid system of primary and territorial care, as urged by the WHO. The result is that the most costly and complex part of the healthcare demand – that linked to ageing and the last stages of life – burdens a hospital system designed for other functions. Here integrative healthcare can and must play a leading role, but in a complementary and solidaristic logic, not as a substitute.
Clearing up
It is essential to clarify also on an ‘ontological’ level, I would like to say, the difference between mutual and insurance. The mutual is an entity participated in by its members, based on democratic governance and intergenerational solidarity; insurance operates according to actuarial and contractual logic. It is not a question of establishing moral hierarchies or good and bad, but of recognising different legal natures and functions. Confusing the two plans produces regulatory distortions.
The ‘5Rs’ paradigm
That is why we welcome the introduction of technical supervision, but demand that it should not be limited to the economic-financial aspects. Capital sustainability is essential, but it is not enough. We must measure health outcomes, the quality of services, and the effective contribution to reducing inequalities. Regulation must be appropriate to the entity being supervised and consistent with its social function. For years now, as a cooperative system, we have been proposing a clear paradigm: the 5Rs. Single direction, to overcome institutional fragmentation. Clear rules, homogeneous throughout the country. Defined roles, distinguishing integration from substitution. Territorial networks, because welfare is not the sum of isolated pieces but a jigsaw puzzle to be framed organically. Human resources, making the most of general practitioners, service pharmacists, sociomedical cooperatives and mutual societies in an integrated architecture.
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