Chronic diseases, unfortunately, represent the number one leading cause of death in the world. There is a particular incidence in Europe where, according to WHO, chronic diseases comprise 86% of the total number of deaths. These numbers are also high in Italy, affecting 24 million Italians according to the 2019 Italian Observatory on Healthcare Report.
An individual affected by a chronic disease requires prolonged medical treatment to alleviate symptoms and improve quality of life. Yet what healthcare rights does the government offer patients suffering from chronic diseases? What protection does the Italian legal system provide?
Chronic diseases and invalidity
Patients affected by one or more chronic conditions are generally recognized a certain percentage of civil incapacity, which allows for specific types of government aid including, in more serious cases, a disability pension. The percentage of civil incapacity officially established is the determining factor for the types of benefits and compensation a patient can claim. Patients with civil incapacity equal to or greater than 34% are entitled to government aid and prosthetics. If the percentage of civil incapacity increases to 46%, the patient can register for targeted employment services. Civil incapacity equal to or greater than 50% entitles patients to special leaves of absence for treatments and civil incapacity over 67% entitles patients to a partial co-pay exemption for specialist medical services. Patients with civil incapacity equal to or greater than 74% and a low income can claim a monthly healthcare allowance. Disability pensions may only be claimed by patients with civil incapacity of 100%. Finally, if the disease prevents the patient from walking, an accompaniment allowance is provided regardless of a patient’s income.
The list of chronic diseases that give entitlement to one or more of the services listed is available at the following link.
Exemption from paying the healthcare co-pay ticket
As mentioned above, a patient with a percentage of civil incapacity equal to or greater than 66% can benefit from a reduction in the co-pay ticket for healthcare services. Even so, patients affected by chronic diseases are not obliged under any circumstances to pay a co-pay for medical services, as established by Prime Ministerial Decree dated 12/01/2017. Chronic diseases and conditions that are exempt from co-pays (i.e. cirrhosis of the liver, Alzheimer’s, diabetes and HIV infections) are listed in Annex no. 8 of the decree. In order to be eligible for the exemption, a certificate must be submitted to the local health authorities (ASL) attesting the existence of one or more of the diseases listed in the Annex.
Patients should be aware that some certificates have an expiration date (decided upon by each region individually), in which the certificate must be renewed through a medical visit considering the minimum periodsof validity established by law.
Continuing to work with a chronic disease may be particularly burdensome, especially when the disease is degenerative. For this reason, in 2003 legislative decree no. 276 granted public and private employees with chronic diseases the right to change from full-time to part-time work by presenting their employer with certification of the disease. Employers cannot oppose the request to revert to part-time and under no circumstances may they oppose the employee’s decision to return to full-time in the future.
That’s not all. An employee affected by a chronic disease may require leaves of absence for medical visits or treatments. These leaves depend on the applicable CBA and may or may not be paid or may be subtracted from the total number of hours the employee is entitled to as leaves of absence. If leaves are taken on a continuous basis (i.e. for a specific treatments), they may be calculated as sick time. The employee thus has the right to remain at home if the disease, like any other illness, makes it impossible to carry out the work day, but must be at home during specific hours of the day as INPS (National Institute of Social Security) doctors can make home calls to verify real illness. If the employee is not at home when the INPS doctor arrives, his or her absence must be justified by a medical visit, out-of-home treatment or presence in a different location that is more suited to improving the employee’s condition.
Finally, employees with a chronic disease that have civil incapacity of at least 50% can claim a special leave of 30 days per year to use for needed treatments.