Sussidio Didattico Sussidio Didattico
Training course on the right to Health and the access to social
and sanitary services
Section
for foreign citizens
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This publication is created by FOCSIV - Volontari nel mondo within the project “Immigrazione e tutela della salute. Un’esigenza di solidarietà umana per un’equa inclusione sociale”, cofinanced by Italian Ministry of Labour and Social Policies, L. 383/2000, art. 12, lett. f) – financial year 2009.
Contacts:
Barbara Ghiringhelli Valentina Pierucci [email protected]
This document is available on www.focsiv.it
Published June 2011, by FOCSIV, Via San Francesco di Sales, 00165, Roma, Italia Editing: Donato Argentiero
FOCSIV - Volontari nel mondo is the biggest Italian Federation of voluntary service Christian organizations. The Federation counts at present 65 organization members, with a membership base of 7.624 people, 490 groups and over 60.000 supporters. FOCSIV employs over 1.000 volunteers in our 660 projects and about 6.000 workers in developing countries. Over 5.000 volunteers cooperate to carry on the initiatives promoted both in Italy and abroad.
Since 1972 FOCSIV is involved to contribute to the struggle against every form of poverty and marginalization; the affirmation of human dignity and human rights; to protect and promote human rights and the growth of communities and local institutions, in agreement with evangelical values and according to the Social Doctrine of the Church.
Since its birth more than 16.000 Italian volunteers have served for several years in countries in need, to contribute to self-development. Our volunteers are employed in many development projects dealing with healthcare, agriculture, education, protection of human rights and institutional strengthening.
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FOREWORD
The World Health Organization (WHO) defined in its Constitution (adopted in New York in 1946 at the International Conference on Health) the relation between rights and health:
“Health is a state of complete physical, mental and social well-being not merely the absence of disease nor the absence of infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States…”
The right to health is a wide ratified and proclaimed human right as shown by art. 25 of the Universal Declaration of Human Rights and as declared in many International Conventions. At national level, Italian Constitution dedicates its art. 32 to the right to health; nonetheless, it is often very difficult to assert this right for disadvantaged people.
On one hand, migrants often suffer for a lack of awareness of their rights. On the other hand, migrants and, generally, disadvantaged people have to face difficulties in accessing to healthcare services because of different barriers that limit this right: lacks of communication and of dialogue, economic, legal, administrative barriers restrict the access to the welfare services.
In 2008, the resolution “Health of migrants” endorsed by the 61st World Health Assembly stated the importance of migrant-friendly policies, and promoted a fair access to the right to health and to the prevention and care services, without inequalities based on sex, religion, nationalities or origin.
This resolution (WHA 61.17) officially recognizes the role of health in integration and inclusion process; it also underlines the importance of training for social and health workers, who face the need of migrants. At European level, we can mention the recommendations of the European Parliament at the international Conference “Health and Migration in the EU: better health for all in an inclusive society” (Lisbon, 2007), and the final Declaration of the Eighth Conference of European Health Ministers in Bratislava (2008) stating that “Well-managed migrants’ health measures, including public health, promote the well-being of all and can facilitate the integration and participation of migrants within the host countries by promoting inclusion and understanding, contributing to social cohesion and enhanced development”.
Two other recent resolutions of European Parliament (2010/2089 (INI) of 8th March, 2011 and 2010/2276 (INI) of 9th March, 2011) emphasize that migrants and Roma face inequalities due to a large number of factors influencing health: education, professional level, income, health care, disease prevention, health promotion and public policies that affect the quantity, quality and distribution of these factors.
Awareness about right to health and about the link between health and inclusion is still too weak at local, national and European level.
In this framework, this easy training instrument aims to inform foreign citizens about their rights and about the Italian health care system; on the other hand, we also aim at helping social workers on the theme of “cultural competent care” in their social and sanitary work.
Sergio Marelli FOCSIV Secretary General
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In questo documento
Italian law protecting the right to health for migrants 6
The right to health for migrants: a human international right – WHO 6 The right to health for migrants: a human International right – EU 6
Italian laws on immigration 6
Conclusions 8
From the right to health to the acce sto health: “migrant friendly” services focused on human
being 9
Health and Social Inclusion 9
Possibile guidelines 9
FOCSIV activities on “migration and development” 9
Conclusions 11
Female Genital Mutilations: understand, reconsider and renew the traditions for women’s
rights 12
Female Genital Mutilations 12 Categorization of FGM by WHO 12 Reasons for FGM 12 Physical and psycological consequences 13 Legal consequences 13 Why should we abandon female genital mutilations 14 FGM in the context of migration 14 Vademecum Immigration how, where, when “Handbook for Integration” 16
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Enrolling in the National Health Care System (SSN) 16 The Health Care Card 18 National Healt Care Services 18 Temporarily Present Foreigners (STP) 23 Report on reducing health inequalities in the UE (2010/2089(INI)) 25 Motion for a european parliament resolution on reducing health inequalities in the EU 25 Opinion oh the Committee on the internal market and consumer protection 36 Opinion of the Committee on womwn’s rights and gender equality 40
Sites Links 44
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Italian law protecting the right to health for migrants
1The right to health for migrants: a human international right – WHO
• International resolution on “The Health of Migrants” by WHO (World Health Organization) in Geneva (2008), calls for the promotion of health policies sensibles towards migrants in order to guarantee them the right to health and the prevention without any discrimination due to sex, age, religion, nationality, race.
• WHO resolution officially recognizes the role of health in integration/inclusion process.
• This resolution is crucial in order to recognize the right to health as a human right, essential for the individual and for the society.
The right to health for migrants: a human International right – EU
• In 2007, the European Ministries for Health declared that health policies for migrants (…) promote the well-being for all and facilitate integration and the participation of migrants within the countries of destination, enhancing inclusion and dialogue, contributing to mutual comprehension and fostering the development.
• But for many migrants the right to health is still a “useless right”.
• Too many barriers indeed (bureaucratic, linguistic, economic, legal) restrict the right to health for the most vulnerable parts of a society, including migrants.
Italian laws on immigration
• Until 80s, in Italy there are no specific laws on immigration.
• Since 1986, we have many laws on migration; these laws are quite fragile for the small economic resources.
• Italian laws on immigration were focused on specific aspects, as expulsions/family reunion/workers’ rights… and they did not understand that migration was about to become a stable reality in Italian society.
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1 By VALENTINA PIERUCCI, Programma Migrazioni e Co-Sviluppo FOCSIV
• The principal law in Italy dealing with the right to health for immigrants is the N. 286 of 1998 “Testo unico delle disposizioni concernenti la disciplina dell'immigrazione e norme sulla condizione dello straniero”.
• Health assistance for immigrants is under articles 34, 35 and 36.
Art. 34
Health Care for foreign citizens enrolled in National Health Care System (SSN)
• The National Health Care System (SSN) is a collection of structures and services that ensure health protection and health care assistance for all Italian and foreign citizens.
• The foreign citizens residing in Italy, with a legal Permit to Stay, have the right to the health care assistance insured by the National Health Care System (SSN), with equal treatment compared to Italian citizens
• The health care assistance covers the family members who are legal dependents and legally staying in Italy.
• Enrolment in National Health Care System (SSN) is compulsory for some categories of immigrants.
• Enrolment is valid for the entire length of the period of validity or of renewal of the Permit to Stay or the EC long-term residence permit.
• Foreign citizens not enrolled in SSN must insure themselves or they can voluntarily enrol to SSN.
Art. 35
Health Care for foreign citizens not enrolled in National Health Care System (SSN)
• Foreign citizens not enrolled in National Health Care System (SSN) have to pay a fee for health services.
• Foreign citizens who do not have a Permit to Stay or they have a Permit to Stay that has been expired for more than 60 days, are guaranteed urgent and essential out-patient and hospital care for illness and injuries and preventive medicine interventions to safeguard individual and collective health, at public and accredited structures.
• Foreign citizens who are illegally present in Italy are assigned an identification code, called the “STP” (Temporarily Present Foreigner), which is valid for 6 months and is renewable.
• When an illegally present foreign citizen (STP) in Italy goes to the health structures, she/he is not reported to the police authorities.
Art. 36
Permit to Stay for medical treatment
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• Foreign citizens who enter Italy for medical treatment can not enrol in the SSN and they are personally responsible for payment of bills related to the treatments carried out.
• In order to obtain the special visa for medical treatment, the foreign citizen has to declare where and how long he/she will be hospitalized; he/she has to pay a deposit; and so on.
• The Permit to Stay is directly linked to the treatment.
• The new law on security “Pacchetto sicurezza” (law n. 94/2009) does not modify the regulation of health care assistance.
• Introducing the "crime of illegal immigration", however, this law raises several concerns for the rights of foreign citizens and also for public health.
• It should be noted, however, that the prohibition to report illegal foreign citizens to the police authorities remains valid.
• So, when an illegally present foreign citizen (STP) in Italy goes to the health structures, she/he is NOT reported to the police authorities!
Conclusions
• The right to health is a fundamental human right.
• It is necessary that laws and national policies aim to protect and promote the right to health for all, national and foreign citizens living in Italy.
• It is necessary to foster relations between beneficiaries and national and local health structures, the use of cultural mediators, and the establishment and support of training courses for Italian health professionals.
• Health for integration: promoting access to social health services must be part of a process of active inclusion of foreign citizens.
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From the right to health to the acce sto health: “migrant friendly”
services focused on human being
2Health and Social Inclusion
• The right to health and the access to health services are necessary to achieve an active inclusion and they are also very important for the well being of whole society.
• Nevertheless, the right to health is often restricted in terms of care and prevention.
• The relation between the right to health and social integration is very deep; this link should be organized with specific intervention focused on specific targets.
Possibile guidelines
• Pay attention to the universal promotion of the right to health.
• Social and health services focused on human being.
• Analysis, researches and data are specific and they should be integrated with a communication strategy.
• The collaboration between social and institutional networks should be enhanced.
• Foreign citizens living in Italy should be considered as a part of the society not as a
“problematic group”.
FOCSIV activities on “migration and development”
1. Project cofinanced by Italian Works and Pensions Department - Financial year 2006:
“Impegno sociale tra Nord e Sud del mondo. La nuova frontiera dell’inclusione socio- economica degli immigrati”
2. Project cofinanced by Italian Works and Pensions Department - Financial year 2007: “Il nuovo Cittadino. La famiglia protagonista dell’inclusione del migrante”
3. Project cofinanced by Italian Works and Pensions Department - Financial year 2008:
“Immigrati boliviani e peruviani: cittadini attivi attraverso una concreta inclusione sociale”
2 By VALENTINA PIERUCCI, Programma Migrazioni e Co-Sviluppo FOCSIV
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4. Project cofinanced by Italian Works and Pensions Department - Financial year 2009:
“Immigrazione e tutela della salute. Un’esigenza di solidarietà umana per un’equa inclusione sociale (Immigration and health care. A human need of solidarity to achieve a fair social inclusion)”
The present initiative looks at the care and the access to the right to health and to health services for immigrants in Italy.
Health is a universal human right, defined by the WHO as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
With this projects, FOCSIV Volontari nel mondo aims to ride over the difficulties caused by the lack of communication and the lack of knowledge of the migrants. On the other hand, third sector professionals are not often trained to face migrants’ worries and steer their choices to the welfare services. We intend therefore to facilitate the dialogue and the knowledge, both for migrants and third sector professionals, of the possibilities to access to health care services in Italy.
5. Research: “Models of interaction and communication in a multicultural society:
information on health dedicated to migrants”
• This research has been financed by region Lombardy and realized by FOCSIV and other partners. The overall objective is to sensitize and train migrant communities about health care and services.
• The partners will realize guidelines for communication on health services; the creation of a multimedia documentary for schools; the realization of a spot.
• The research will focus on data collection and research on female genital mutilations in order to understand this tradition and sensitize public awareness on this issue – above all migrant women.
• The beneficiaries of this research are migrant women and students in Lombardy's high schools.
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Conclusions
• The right to health is part of human rights and should be guaranteed to everyone.
• The access of migrants to the right to health and to the health services is necessary to assure a full social and health inclusion even if many barriers still restrict this possibility.
• Health services must be territorial and focused on specific target: different communities in different places have different needs!
• It is also important to give attention to communication and cultural mediation; cultural differences can enhance difficulties in communication, reducing dialogue and restricting the awareness of rights and resources in a country.
• We must promote the participation of foreign citizens in social life in order to create a real inclusive process and achieve a full integration.
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Female Genital Mutilations: understand, reconsider and renew the traditions for women’s rights
3Female Genital Mutilations
• Female Genital Mutilations: all procedures that involve partial or total removal of the external female genitalia; FGM have uncertain origin and they represent very ancient traditions.
• FGM can be named as female circumcision, excision, cutting, infibulation, sunna: these are specific types of procedures.
Categorization of FGM by WHO
9 Type 1: the partial or total removal of the clitoris and/or the prepuce (also known as sunna);
9 Type 2 : partial or total removal of the clitoris, the prepuce and the labia minora, with or without excision of the labia majora (also known as excision);
9 Type 3 : narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris (also known as infibulation);
9 Type 4 : all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization .
Reasons for FGM
Different communities justify the practices:
9 Hygienic reasons
9 Social reasons (adulthood, marriage) 9 Sexual reasons (reduce woman’s libido)
Female genital mutilations are a mean to be more integrated, to preserve virginity, to become a “real”, adult woman.
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3 By VALENTINA PIERUCCI, Programma Migrazioni e Co-Sviluppo FOCSIV
Physical and psycological consequences
• Agonizing pain due to lack of anesthesia, hemorrhages and infections due to urine retention, the use of non-sterile equipment and the application of local dressings of animal feces and ashes; infections can result in death.
• Irregular bleeding and vaginal discharge, dysmenorrhoea, vulvar cysts, infertility.
• About 50% of infibulated women need an "anterior episiotomy“ (defibulation) to facilitate sexual acts and to have a baby.
• Many women who have undergone FGM suffer psychiatric problems; they were also more likely to have relational problems or in some cases had fears of establishing a relationship.
Legal consequences
• As Western governments become more aware of FGM, legislation has come into effect in many countries to make the practice a criminal offense.
• In 2008, UNDP, OIM, UNESCO, UNHCR, UNIFEM and others International Organizations signed an interagency statement in order to “Eliminate Female Genital Mutilation”.
• In 2003, the African Union adopted the Maputo Protocol promoting women's rights including and to end female genital cutting. Many African countries have specific laws against FGM: Burkina Faso, Ivory Coast, Ethiopia, Egypt, Ghana, Guinea, Centro African Republic, Senegal, Tanzania, Togo, Uganda.
• In Italy, the Law n°7/2006, concerning "Measures of prevention and prohibition of any female genital mutilation practice", punishes any practice of female genital cutting and/or mutilation "not justifiable under therapeutical or medical needs" with imprisonment ranging from 4 to 12 years.
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Why should we abandon female genital mutilations
• Over 6,000 communities have chosen to abandon the practice of female genital mutilation FGM in Africa, according to a joint United Nations programme designed to eliminate this practice, and the number is growing.
• Effective abandonment of FGM requires a process of community discussion, decision and public commitment.
• Families will not abandon FGM on their own. They will act only when they believe that social expectations have changed, and that most or all others in their community will make the same choice around the same time.
• In addition to thinking of "education", we must provide alternative means for women to choose to abandon FGM.
• We could build a basis for dialogue by offering alternatives that are culturally acceptable in specific contexts, respect human rights for all, men and women, boys and girls.
FGM in the context of migration
• Due to international migration, Female Genital Mutilations (FGM) have become an issue of increasing concern in host countries such as Italy.
• Immigration in Italy in recent years has increased significantly, and there are also new questions to be answered. A typical example is given by the issue of female genital mutilation, in which Europe and Italy found themselves directly involved in the aftermath of the growing number of arrivals of foreign women.
• Probably, the sense of female genital mutilations varies between the first and subsequent generations of migrants, so it is important to think to raise awareness, to inform, to train and communicate in a well-differentiated way, depending on the beneficiaries.
• Today you have to create professionals who can support and protect women who have rebelled against these practices. Health workers and nurses are the first who can identify social issues related to the mutilation. Nurses must be prepared to treat the subject with patients. Through specific questions and being scientifically trained, they will be able to discourage the practice.
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Film “Moolaadé”
Moolaadé ("magical protection") is a 2004 film by the Senegalese writer and director Ousmane Sembène. It addresses the subject of female genital mutilation. The film was a co-production between companies from several nations: Senegal, France, Burkina Faso, Cameroon, Morocco, and Tunisia. It was filmed in Burkina Faso.
The film is set in a village in Burkina Faso. The film argues strongly against the practice, depicting a village woman, Collé, who uses moolaadé (magical protection) to protect a group of girls. She is opposed by the villagers who believe in the necessity of female genital cutting, which they call "purification“;
the end of film implies the change, with the mothers that change their minds and abandon female genital cutting.
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Vademecum Immigration how, where, when “Handbook for Integration”
4Enrolling in the National Health Care System (SSN)
The National Health Care System (SSN) is a collection of structures and services that ensure health protection and health care assistance for all Italian and foreign citizens. The foreign citizens residing in Italy, with a legal Permit to Stay, have the right to the health care assistance insured by the National Health Care System (SSN), with equal treatment compared to Italian citizens. The health care assistance covers, in addition to those who are enrolled, the family members who are legal dependents and legally staying in Italy.
Where do I go to enrol?
Enrolment takes place at the Local Public Health Corporation (ASL) of the territory in which you have your residence or, if you have not declared your residence, according to the area in which the address that appears on your Permit to Stay is found.
What is the Local Public Health Corporation (ASL)?
The Local Public Health Corporation is a collection of hospitals, doctors’offices, family planning clinics and offices that, in a local government context (for example in a province), that provides for the health of the population. At the ASLs, it is possible to request to be enrolled in the National Health Care System (SSN) and to choose one’s personal general practitioner (or family doctor).
Can I enrol in the National Health Care System (SSN)?
Enrolment in the National Health Care System is compulsory for foreign citizens who own:
• an EC long-term residence permit;
• a Permit to Stay for subordinate employment;
• a Permit to Stay for self-employment;
• a Permit to Stay for enrolment in the job-placement lists;
• a Permit to Stay for family reasons;
• a Permit to Stay for political asylum;
• a Permit to Stay for humanitarian asylum;
• a Permit to Stay for expected adoption;
• a Permit to Stay for foster care;
• a Permit to Stay for acquiring citizenship.
Those foreigners who are waiting for the renewal or issuance of the Permit to Stay do not loose the right to be enrolled, or if they are not enrolled, they can still enrol themselves. Family members also have the right to enrolment if they are legal dependents.
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4 The handbook, Immigration: how, when, where, was developed by the Ministry of Labour and Social Policies
Warning: foreign citizens who enter Italy for medical treatment can not enrol in the SSN and they are personally responsible for payment of all bills related to the treatments carried out;
Foreigners who are political refugees and stateless people and their spouses can enrol in the SSN under the same conditions as Italian citizens, provided they have a Permit to Stay for political asylum that is still valid.
Foreign children who are minors and whose parents are enrolled in the S.S.N. are insured, from the moment they are born, the same treatment as Italian enrolled minors.
When is enrolment in the National Health Care System not allowed?
One cannot be enrolled if one’s Permit to Stay is not renewable or in case of expulsion, unless the person is able to provide evidence that an appeal has been made against the same expulsion.
What documents do I have to present in order to enrol myself in the National Health Care System?
• A valid Permit to Stay; if the Permit is being renewed, then you can present the expired permit along with the receipt for the renewal (issued by the Office of the Chief of Police or the post office);
• a certificate of residence (or declaration of regular abode as written on the Permit to Stay);
• tax code;
• a declaration in which one takes on the responsibility of communicating any variation of their own status.
In addition:
• the unemployed people who are enrolled in the Employment Offices have to self-certify that they are enrolled in the Employment Agency;
• those foreigners who are married to Italian citizens have to provide a certificate of their family status or self-certification;
• minors in foster care or awaiting adoption must provide a declaration from the Juvenile Court verifying their state of pre-adoption or foster care.
How long does enrolment in the National Health Care System last?
Enrolment is valid indefinitely for the entire length of the period of validity or of renewal of the Permit to Stay or the EC long-term residence permit.
When does enrolment in the National Health Care System stop?
Enrolment in the National Health Care System stops:
• if the Permit to Stay expires, unless the request for renewal or the renewed Permit to Stay are exhibited;
• if the Permit to Stay is revoked or annulled, unless it can be demonstrated that an appeal is in process;
• in case of expulsion;
• when the conditions allowing the foreigner to belong to the category of people obligatorily enrolled in the SSN cease to exist (for instance: the end of cohabitation for dependent family members; the conversion of the residence permit in a different type of permit for which the obligatory enrolment in the SSN is not foreseen; the conclusion of
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the employment activity or the end of a foreigner’s enrolment in the Employment Offices if the foreigner does not have the type of Permit to Stay that makes enrolment in the SSN obligatory).
What documents and social-health services do people enrolled in the National Heath Care System have access to?
• The health care card;
• the selection of a family physician and a paediatrician for one’s children;
• general medical examinations in clinics and medical examinations with specialists;
• medical exams at home;
• hospital admittance;
• vaccinations;
• the blood exams, x-rays, ultrasound, etc.;
• prescriptions for medicine;
• certificates and legal-medical services;
• rehabilitation assistance, prostheses, etc.
The Health Care Card
What is the health care card?
It is the document issued by the A.S.L. that demonstrates that you have enrolled in the SSN. It is essential in order to access the available health services. The name and surname of the person who is enrolled as well as the name of the general practitioner are written on the card.
What do I do if I loose my health care card?
You must go to the competent local authorities, report the loss and then request a duplicate from the ASL to which you belong.
National Healt Care Services
Who is the general practitioner (or family physician)?
Your general practitioner is the professional who ensures that you receive general medical care:
• she/he examines patients in her/his own office or at the homes of those who are sick when the health conditions do not permit the patient to go to the physician’s office;
• she/he prescribes medicine, analyses and exams with specialists;
• she/he recommends hospitalization if necessary;
• she/he supplies certificates.
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Who is the family paediatrician?
She/he is the physician that looks after children, periodically gives them physical examinations, checks their growth, prescribes medicines, analyses and exams with specialists, she/he also recommends hospitalization if necessary, and issues certificates.
How do I choose a family physician and family paediatrician?
The person enrolled in the SSN can choose the family physician and the family paediatrician for their children who are between 0 and 14 years old and have the right to have a physician specialized in paediatrics.
At the office that issues the health care card it is possible to consult a list of available physicians. The name of the family physician is then printed on one’s personal health care card.
Are the certificates that are issued by the family physician and the family paediatrician free?
The following certificates are free:
• the certificate allowing a parent to be absent from their job when their child is ill;
• the certificate for carrying out non-competitive sports activities in connection with school;
• the certificate of illness or injury or other motives for temporary inability to work.
The following certificates are not free:
• a certificate for competitive sports activities;
• a certificate to be used for insurance practices;
• a certificate to be used for the request for the recognition of a person’s status as a disabled person.
Can I revoke or replace my family physician at any moment?
Yes, by filling out a special form; at the same time you must also choose a new physician.
How does one have an examination with a specialist?
To have an exam with a specialist, it is necessary to visit and obtain a special request for the specialist from the family physician first.
With the family physician’s request and the health care card in hand, you must go to the office of appointments at the ASL in order to book an appointment for this special health service.
These services can also be carried out at doctors’ offices and at private laboratories if they are covered by the insurance.
Are the medical examinations with specialists free?
For medical examinations with specialists, laboratory examinations and the purchase of medicines it is necessary to pay a fee that is pre-established by the Government, the ticket.
The ticket for medicine does not have to be paid by:
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• disabled people who are 100% disabled (disabilities are measured in 3 levels), civil invalids with a disability above the 2/3rds level, or invalids who receive government assistance in order to pay for nursing or other help due to a disability, blind people and deaf/mute people;
• victims of terrorism and organized crime;
• patients subjected to painful therapies;
• welfare recipients;
• retirees with the minimum pension, who must be more than 60 years old.
For services from medical specialists, the following are exempt from paying the ticket:
• welfare recipients and any of their legally dependent family members;
• unemployed people, retirees who receive the minimum pension rate and are older than 60 years-old;
• people with a disability above the 2/3rds level, or invalids who receive government assistance in order to pay for nursing or other help due to a disability;
• people injured at the workplace and all categories of citizens who are exempt from working due to pathologies or conditions identified by special laws.
For some medical services it is not necessary to pay the ticket, even if the citizen is not part of any of the categories listed above. These services are:
• procedures for the early diagnosis of the tumours (mammography, pap tests, etc.);
• services aimed at protecting maternity, for example, analysis, ultrasound, etc.;
• services for promoting blood, organ and tissue donations, and non-obligatory vaccinations for children under 14 years old.
How do I obtain exemption from paying tickets?
By presenting the request to the ASL, accompanied by a certificate from a medical expert or hospital physician, your health care card, and your tax code.
The ASL then issues a card that permits multiple prescriptions for up to a maximum of 6 portions of the medicine required for the pathology.
Warning: regulations about exemptions are sometimes emended. For information about the current set of norms about exemption and about the documents to be submitted, you can ask your family physician and family paediatrician.
What are the emergency services?
In the cases of serious urgency (accidents, injuries and any situation where a life is in danger) you can reach the Emergency Room (Pronto Soccorso) of a hospital or request medical services by dialling the free telephone service, “118”, that works 24 hours a day.
Is hospital assistance free?
Hospital services are free for all those who are enrolled in the National Health Service system.
The financial law 2006 provides that from 1 January 2007 it is necessary to pay a for a ticket on emergency room services that are not classified as urgent (code white or “codice bianco”).
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What is the “doctor on duty” (la guardia medica)?
It is a totally free service that can be called at any time in the case of serious need; it offers immediate medical assistance at your home.
Is nursing assistance included in the National Health Care System?
Currently this type of assistance is not included by the National Health Care System. If necessary, however, it can be offered, at home, if the social services of the Municipality report it to the health authorities.
Can health examinations and treatments be imposed?
Only in the cases provided for by the law (“Obligatory Sanitary Treatments”) but always with respect for the dignity and civil rights of the individual. These interventions are arranged if the Mayor issues a measure, following the proposal made by a physician, to be corroborated by a physician from the responsible health structure. 48 hours following hospital admission, the initiative must have been communicated to the responsible tutelary Judge.
Can anyone oppose an obligatory health treatment?
The person who is submitted to the treatment, or who has a stake in the situation, can present the Court with an appeal against the provision (corroborated by the tutelary Judge) for hospitalization.
What happens if the hospitalized citizen is foreign or stateless?
The provision must be communicated to the Ministry of the Interior and to the consulate of the Country to which the in-patient belongs or with which she/he is affiliated. The Prefect takes care of the communication.
What are the family planning clinics (consultori familiari)?
They are local social-health services that protect the physical and psychological health of women, children, couples and families. All the services offered by the family planning clinics are free and it is possible to enter the clinics for access to these services by appointment. The service is also available to foreigners. The professionals in the family planning clinics have both psychological and social skills: psychologists, social assistants, sociologists, cultural mediators, as well as health skills: paediatricians, gynaecologists, midwives, nurses,
health assistants, etc.
You can go to the family planning clinics for the following services:
• consultations and examinations regarding contraception;
• for assistance during pregnancy;
• for courses in preparation for giving birth;
• consultations, examinations and certificates for the voluntary interruption of a pregnancy (IVG);
• periodic gynaecological check-ups;
• prevention of female tumours;
• consultation and assistance during menopause;
• paediatric assistance;
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• obligatory (and recommended) vaccinations;
• counselling regarding social and psychological problems.
Where can I find the family planning clinics?
In the telephone directory, under “Aziende sanitarie locali” (Local Health Offices) for those clinics that are public and under “Consultori” (Clinics) for those that are private.
Are there any other local social sanitary services I can access?
Yes, the Local Rehabilitation Units (Unita territoriali di riabilitazione, UTR) and Mental Health Centres (Centri di igiene mentale, CIM).
When and which vaccinations are compulsory?
For children in Italy the vaccinations against tetanus, diphtheria, poliomyelitis and hepatitis B are compulsory. Vaccinations against chickenpox, pertussis (whooping cough) and, only for children, against German measles are recommended but not compulsory. For adults the vaccinations against tetanus and viral hepatitis B are recommended.
Are compulsory vaccinations free?
Yes.
Under which circumstances can one be asked to present a certificate of vaccinations?
• When enrolling in elementary school;
• when enrolling in nursery school;
• when enrolling in a day-care centre,
• when enrolling in the summer recreational centres, for taking part in competitive sports activities, etc.
Who can voluntarily enrol in the National Health Care System?
Non-European Union foreign citizens, for whom enrolment in the SSN is not compulsory, must nonetheless insure themselves against the risk of illnesses, accidents and maternity.
They can meet this requirement by:
• stipulating an insurance policy with an Italian or foreign insurance institute, as long as the policy is valid in Italian territory;
• by voluntary enrolling in the National Health Care System after paying the minimal annual fee in proportion to the declared income.
The following have the right to voluntary enrolment in the Health Care System (paying an annual fee):
• students;
• au pairs, as defined by the European Accord of Strasbourg of November 24th, 1969 (ratified with law n.304, 18 May, 1973);
• religious people;
• people with permits to stay for elective residence who do not carry out any work activity;
• • accredited foreigners who work in the Embassy in Italy;
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• all other people who are not required to enrol and are not listed above.
Which documents must I present in order to voluntarily enrol in the National Health Care System?
• A valid Permit to Stay; if the Permit is being renewed, then you can present the expired permit along with the receipt for the renewal (issued by the Office of the Chief of Police or the post office);
• a certificate of residence (or declaration of current abode as seen on the Permit to Stay);
• your tax code;
• a receipt demonstrating that you have paid.
Those who have to produce a further certification include:
• students (self-certification of enrolment in the course of study);
• foreigners working as au pairs (a declaration of the status of the foreigner working as an au pair).
What do I have the right to if I do not have a valid Permit to Stay?
Foreign citizens who are not in keeping with the norms related to entry and/or to the stay in Italy because they do not have a Permit to Stay or they have a Permit to Stay that has been expired for more than 60 days, are guaranteed urgent and essential out-patient and hospital care for illness and injuries and preventive medicine interventions to safeguard individual and collective health, at public and accredited structures.
Among the preventive medicine interventions are the following:
• interventions for social protection during pregnancy and motherhood;
• vaccinations;
• interventions for international prophylaxis;
• prophylaxis, diagnosis and care of infectious diseases;
• activities aimed at protecting mental health.
Temporarily Present Foreigners (STP)
Foreign citizens who are illegally present in Italy are assigned an identification code, called the
“STP” (Temporarily Present Foreigner), which is valid for 6 months and is renewable.
When an illegally present foreign citizen (STP) in Italy goes to the health structures, she/he is not reported to the police authorities, except in the cases in which the law obliges the health structures to report them.
Can I access health services if I do not have the money to pay the ticket?
If the foreign citizen does not have enough money, she/he will only pay a part of the ticket (a share of the fee).
A foreign citizen who is totally without money (a situation of indigence) can be exempt from paying the share of the expenses for the ticket, if she/he signs a “declaration of indigence”, which is valid for 6 months.
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What services do I have a right to, even if I do not have the money to pay the ticket?
As is true for Italian citizens, the illegally present foreigner (STP) in a state of indigence (complete poverty) is exempt from paying the ticket in the following cases:
• first level health services;
• emergencies;
• state of pregnancy;
• pathologies that are exempt from payment;
• subjects who are exempt due to their age or because they are affected by a serious disability.
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Report on reducing health inequalities in the UE
5(2010/2089(INI)) Motion for a european parliament resolution on reducing health inequalities in the EU
The European Parliament,
- having regard to Articles 168 and 184 of the Treaty on the Functioning of the EuropeanUnion,
- having regard to Article 2 of the Treaty on European Union,
- having regard to Article 35 of the Charter of Fundamental Rights of the European Union, - having regard to Article 23 of the Charter of Fundamental Rights of the European Union,
which deals with equality between men and women in all areas,
- having regard to the Commission Communication entitled ‘Solidarity in health: reducing health inequalities in the EU’ (COM(2009)0567),
- having regard to Council Decision 1350/2007/EC of 23 October 2007 establishing a second programme of Community action in the field of health (2008-13)6,
- having regard to Council Decision 2010/48/EC of 26 November 2009 concerning the conclusion, by the European Community, of the United Nations Convention on the Rights of Persons with Disabilities7,
- having regard to the Social Protection Committee Opinion on ‘Solidarity in health:
reducing health inequalities in the EU’,
- having regard to the Council Conclusions of 8 June 2010 on ‘Equity and Health in All Policies: Solidarity in Health’,
- having regard to the report on the second joint assessment by the Social Protection Committee and the Commission of the social impact of the economic crisis and of policy responses,
- having regard to the Council Conclusions on ‘Common values and principles in European Union Health Systems’ (2006/C 146/01),
- having regard to the Council Resolution of 20 November 2008 on the health and wellbeing of young people,
- having regard to the Final Report of the Commission on Social Determinants of Health (WHO, 2008),
- having regard to the opinion of the Committee of the Regions on ‘Solidarity in health:
reducing health inequalities in the EU’,
- having regard to its resolution of 1 February 2007 on Promoting Healthy Diets and Physical Activity: a European Dimension for the Prevention of Overweight, Obesity and Chronic Diseases8) and its resolution of 25 September 2008 on the White Paper on Nutrition, Overweight and Obesity-related Health Issues9,
- having regard to its resolution of 9 October 2008 on the White Paper entitled ‘Together for Health: A Strategic Approach for the EU 2008-2013’10,
- having regard to Rule 48 of its Rules of Procedure,
5 Europian Parliament – Committee on the Environment, Public Health and Food Safety Rapporteur: Edite Estrada
6 OJ L 301, 20.11.2007, p. 3.
7 OJ L 23, 27.1.2010, p. 35.
8 Texts adopted, P6_TA(2007)0019
9 Texts adopted, P6_TA(2008)0461
10 OJ C 9 E, 15 January 2010, p. 56.
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- having regard to the report of the Committee on the Environment, Public Health and Food Safety and the opinions of the Committee on the Internal Market and Consumer Protection and of the Committee on Women's Rights and Gender Equality (A7-0032/2011),
A. whereas universality, access to high-quality care, equity and solidarity are common values and principles underpinning the health systems in the EU Member States,
B. whereas, while people live, on average, longer and healthier lives than previous generations, the EU is faced, in the context of an ageing population, with an important challenge, namely the wide disparities in physical and mental health which exist and are growing between and within EU Member States,
C. whereas the difference in life expectancy at birth between the lowest and highest socioeconomic groups is 10 years for men and six years for women,
D. whereas the gender dimension in terms of life expectancy is also a major issue to be addressed in the context of health inequalities,
E. whereas, apart from genetic determinants, health is influenced above all by people’s lifestyles, by their access to healthcare services, including health information and education, disease prevention and treatment for short- and long-term illnesses;
whereas lower socioeconomic groups are more susceptible to poor nutrition and to tobacco and alcohol dependency, all of which are major contributory factors in many diseases and conditions, including cardiovascular diseases and cancers,
F. whereas inequalities in health between people in higher and lower educational, occupational and income groups have been found in all Member States,
G. whereas there is evidence of a gender dimension in malnutrition rates which suggests that women suffer more from malnutrition and that this inequality is exacerbated further down the socioeconomic scale,
H. whereas gender and age inequalities in biomedical research and the under- representation of women in clinical trials undermine patient care,
I. whereas the comparative measurement of health inequalities is a fundamental first step towards effective action,
J. whereas rates of morbidity are usually higher among those in low educational, occupational and income groups and substantial inequalities can also be seen in the prevalence of most specific forms of disability and of most specific chronic noncommunicable diseases, oral diseases and forms of mental illness,
K. whereas the incidence of tobacco use among women, particularly young women, is rapidly rising, with devastating consequences for their future health; and whereas, in the case of women, smoking is aggravated by multiple disadvantage,
L. whereas the Commission has noted that there is a social gradient in health status in all the EU Member States (Commission Communication of 20 October 2010 entitled
‘Solidarity in Health: Reducing Health Inequalities in the EU’); and whereas the World Health Organisation defines this social gradient as being the link between socioeconomic inequalities and inequalities in the areas of health and access to healthcare,
M. whereas numerous projects and studies have confirmed that the onset of overweight and obesity in particular is characterised by early disparities linked to the socioeconomic environment and that the highest incidence rates of overweight and obesity are registered in lower socioeconomic groups; whereas this situation could lead to even greater health and socioeconomic inequalities owing to the increased risk of obesity-related diseases,
N. whereas despite the socioeconomic and environmental progress that has led to an overall improvement in people’s health status over long periods, a number of factors,
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such as hygiene, living and working conditions, malnutrition, education, income, alcohol consumption and smoking, are still having a direct impact on health inequalities,
O. whereas climate change is expected to result in a number of potential health impacts through increased frequency of extreme weather events, such as heat waves and floods, through changing patterns of infectious disease, and via increased exposure to ultraviolet radiation; whereas not all EU countries are equally prepared to address these challenges,
P. whereas health inequalities are not only the result of a host of economic, environmental and lifestyle-related factors, but also of problems relating to access to healthcare, Q. whereas health inequalities are also linked to problems in accessing healthcare, both
for economic reasons (not so much for major treatment, which is dealt with correctly by the Member States, but rather for everyday treatment, such as dental and eye care) and as a result of poor distribution of medical resources in certain areas of the EU,
R. whereas the dearth of medical professionals in certain parts of the EU and the fact that they can easily move to other parts of the EU is a real problem, and whereas this situation is resulting in major inequalities in terms of access to healthcare and patient safety,
S. whereas people living in remote and island areas continue to have limited access to prompt and high-quality healthcare,
T. whereas patients living with chronic diseases or conditions form a specific group which suffers inequalities in access to diagnosis and care, social and other support services, and disadvantages including financial strain, poor access to employment, social discrimination and stigma,
U. whereas violence against women is a widespread phenomenon in all countries and among all social classes and has a dramatic effect on the physical and emotional health of women and children,
V. whereas infertility is a medical condition recognised by the World Health Organisation which has a particular impact on women’s health, and whereas the UK National Awareness Survey has shown that over 94% of women suffering from infertility also suffer from forms of depression,
W. whereas there are wide disparities between Member States in terms of access to fertility treatment,
X. whereas, according to Eurostat, the EU’s statistical office, unemployment across the 27 EU Member States reached 9.6% in September 2010, and whereas the Council of the European Union’s Social Protection Committee, in its opinion of 20 May 2010, expressed concern that the present economic and financial crisis will adversely affect people’s access to healthcare and Member States’ health budgets,
Y. whereas the current economic and financial crisis may have a severe impact on the healthcare sector in several EU Member States, on both the supply and the demand sides,
Z. whereas the restrictions due to the current economic and financial crisis, combined with the consequences of the forthcoming demographic challenge that the Union will have to face, could seriously undermine the financial and organisational sustainability of Member States' healthcare systems, thus hindering equal access to care on their territories,
AA. whereas the combination of poverty and other forms of vulnerability, such as childhood or old age, disability or minority background, further increases the risks of health inequalities, and whereas, vice versa, ill health can lead to poverty and/or social exclusion,
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BB. whereas early years have lifelong effects on many aspects of health and well-being – from obesity, heart disease and mental health, to education, professional achievement, economic status and quality of life,
CC. whereas health inequalities have significant economic implications for the EU and for Member States; whereas losses linked to health inequalities have been estimated to cost around 1.4% of GDP,
DD. whereas in many EU countries equitable access to healthcare is not guaranteed, either in practice or in law, for undocumented migrants,
EE. whereas cases still arise in the Member States of members of various social groups (for example, people with disabilities) being faced with obstacles to equal admission to healthcare establishments, which limits their access to health services,
FF. whereas, with their ageing populations, the Member States are having to deal with problems relating to dependency and an increasing need for geriatric care and treatment; whereas a change in the approach to organising healthcare is therefore needed; and whereas inequalities relating to access to healthcare for elderly people are on the increase,
1. Welcomes the key suggestions made by the Commission in its Communication entitled
‘Solidarity in health: reducing health inequalities in the EU’: (1) making a more equitable distribution of health part of our overall goals for social and economic development; (2) improving the data and knowledge bases (including measuring, monitoring, evaluation, and reporting); (3) building commitment across society for reducing health inequalities; (4) meeting the needs of vulnerable groups; and (5) developing the contribution of EU policies to the reduction of health inequalities;
2. Stresses the importance of healthcare services being provided in a manner consistent with fundamental rights; points to the need to maintain and improve universal access to healthcare systems and to affordable healthcare;
3. Points to the importance of improving access to disease prevention, health promotion and primary and specialised healthcare services, and reducing the inequalities between different social and age groups, and emphasises that these objectives could be achieved by optimising public spending on preventive and curative healthcare and targeted programmes for vulnerable groups;
4. Calls on the Commission and Member States to press ahead with their efforts to tackle socio-economic inequalities, which would ultimately make it possible to reduce some of the inequalities relating to healthcare; furthermore, on the basis of the universal values of human dignity, freedom, equality and solidarity, calls on the Commission and Member States to focus on the needs of vulnerable groups, including disadvantaged migrant groups and people belonging to ethnic minorities, children and adolescents, people with disabilities, with a special focus on mental illness, patients diagnosed with chronic diseases or conditions, older people, people living in poverty, and people affected by alcoholism and drug addiction;
5. Calls on the Member States to ensure that the most vulnerable groups, including undocumented migrants, are entitled to and are provided with equitable access to healthcare; calls on the Member States to assess the feasibility of supporting healthcare for irregular migrants by providing a definition based on common principles for basic elements of healthcare as defined in their national legislation;
6. Calls on the Member States to take account of the specific health protection needs of immigrant women, with particular reference to the guaranteed provision by health systems of appropriate language mediation services; those systems should develop training initiatives enabling doctors and other professionals to adopt an intercultural approach
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based on recognition of, and respect for, diversity and the sensitivities of people from different geographical regions; priority must also be given to measures and information campaigns to combat female genital mutilation, including severe penalties for those who practise it;
7. Calls on the EU and the Member States rapidly to find ways of combating ethnic discrimination, particularly in certain Member States where Council Directive 2000/43/EC has not been implemented and where women from ethnic minorities have little or no social protection or access to healthcare;
8. Calls on the Member States to promote access to high-quality legal advice and information in coordination with civil society organisations to help ordinary members of the public, including undocumented migrants, to learn more about their individual rights;
9. Emphasises that the economic and financial crisis and the austerity measures taken by Member States, in particular on the supply side, may lead to a reduction in the level of funding for public health and health promotion, disease prevention and long-term care services as a result of budget cuts and lower tax revenues, while the demand for health and long-term care services may increase as a result of a combination of factors that contribute to the deterioration of the health status of the general population;
10. Stresses that health inequalities in the EU represent a substantial burden to Member States and their healthcare systems and that the effective functioning of the internal market and strong and, if possible, coordinated public policies on prevention can contribute to improvements in this field;
11. Stresses that countering socio-economic factors such as obesity, smoking, etc., the accessibility of healthcare systems (jeopardised by the non-reimbursement of the cost of care and of medicines, inadequate prevention and the fragmentation of medical demography) and effective diagnosis should be considered key aspects of measures to combat health inequality and that, in addition, the accessibility and affordability of pharmaceutical treatments should also be regarded as a key aspect of individual people’s health; therefore calls on Member States to ensure that the Transparency Directive (89/105/EEC) is being properly implemented and that the conclusions from the 2008 Commission Communication on the Pharmaceutical Sector Inquiry are being appropriately addressed;
12. Stresses that healthcare is not and should not be regarded as a general good or service 13. Calls on the Council and the Member States to evaluate and implement new measures to
improve the effectiveness of their health expenditure, in particular by investing in preventive healthcare so as to reduce future longer-term costs and social burdens, and to restructure healthcare systems in order to provide equitable access to high-quality healthcare (in particular basic medical care) without discrimination throughout the EU, and encourages the Commission to study the use of existing European funds in order to further promote investment in health infrastructure, research and training and to promote and step up disease prevention;
14. Calls on the Commission and the Member States to ensure that equitable access to healthcare and treatment options for older patients are included in their health policies and programmes and to make adequate access to healthcare and treatments for older people a priority for ‘2012 European Year for Active Ageing and Intergenerational Solidarity’; calls on the Member States to promote initiatives in order to tackle social isolation in elderly patients as it has a significant impact on patients’ longer-term health; stresses the need for the European Union and its Member States to anticipate, through an appropriate long-term strategy, the social and economic impact of the ageing of the European population, in order to guarantee the financial and organisational sustainability of healthcare systems, as well as equal and continued delivery of care for patients;
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15. Calls on the Member States to improve their capacity to monitor closely, at national, regional and local levels, the health and social impact of the crisis;
16. Calls on the Commission to foster the pooling of experience in connection with health education, healthy lifestyle promotion, prevention, early diagnosis and appropriate treatments, in particular in relation to drinking, smoking, diet and obesity and drugs; calls on Member States to promote physical activity, good nutrition and ‘Healthy Schools’
programmes targeted at children, in particular in more disadvantaged areas, and to improve levels of personal, social and health education, with view to promoting healthier behaviour and encouraging positive lifestyle-related behaviour;
17. Encourages all the Member States to invest in social, educational, environmental and health infrastructure in line with the principle of ‘health in all policies’,while coordinating measures concerning the qualification, training and mobility of health professionals, thus guaranteeing the capacity and sustainability of the health infrastructure and workforce at both EU and national level;
18. Emphasises that health inequalities in the Union will not be overcome without a common and overall strategy for the European health workforce, including coordinated policies for resource management, education and training, minimum quality and safety standards, and registration of professionals;
19. Calls on the Member States to ensure that information on health, healthy lifestyles, healthcare, prevention opportunities, early diagnosis of diseases and suitable treatments is available in a form and in languages that everyone can understand, using new information and communication technologies, with particular reference to online health services;
20. Calls on the Member States to promote the introduction of telemedicine technologies, which can significantly reduce geographical disparities in access to certain types of healthcare, with particular reference to specialist care, in particular in border regions;
21. Calls on the Member States to promote public policies aimed at ensuring healthy life conditions for all infants, children and adolescents, including pre-conception care, maternal care and measures to support parents and, more particularly, pregnant and breastfeeding women, in order to ensure a healthy start to life for all newborns and avoid further health inequalities, thereby recognising the importance of investing in early child development and life course approaches;
22. Calls on the Member States to ensure that all pregnant women and children, irrespective of their status, are entitled to and actually receive social protection as defined in their national legislation;
23. Recalls the EU’s obligation, under the UN Convention on the Rights of Persons with Disabilities, to guarantee the right of persons with disabilities to the highest attainable standard of health without discrimination on the grounds of disability; insists that the inclusion of disability in all relevant health measurement indicators is a key step towards meeting this obligation;
24. Calls on the EU and the Member States to include the health status of women and the question of ageing (older women) as factors in gender mainstreaming and to use gender budgeting in their health policies, programmes and research, from the development and design stage through to impact assessment; calls on the EU-funded framework research programmes and public funding agencies to include a gender impact assessment in their policies and to provide for the compilation and analysis of gender- and age-specific data with a view to identifying key differences between women and men in relation to health, in order to support policy change, and to introduce and collate epidemiological tools to analyse the causes of the life-expectancy gap between men and women;
25. Considers that the EU and the Member States should guarantee women easy access to methods of contraception and the right to safe abortion;
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26. Calls on the Commission to provide the Member States with examples of good and best practices to encourage more uniform access to fertility treatment;
27. Urges the EU and the Member States to focus on women’s human rights, in particular by preventing, banning and prosecuting those guilty of the forced sterilisation of women and female genital mutilation;
28. Calls on the EU and the Member States to recognise male violence against women as a public health issue, whatever form it takes;
29. Calls on the EU and the Member States to take the necessary measures, in relation to access to assisted reproductive technologies (ART), to eliminate discrimination against women on the grounds of marital status, age, sexual orientation or ethnic or cultural origins;
30. Calls on the Member States to follow the World Health Organisation in recognising obesity as a chronic disease and thus to provide access to obesity-prevention programmes and guarantee access to treatment with proven evidence of a positive medical outcome for persons suffering from obesity who require medical treatment, also with a view to preventing the onset of further diseases;
31. Calls on the EU and the Member States to mainstream gender into tobacco control, as recommended by the WHO Framework Convention on Tobacco Control, and to introduce anti-smoking campaigns targeting young girls and women;
32. Calls on the Member States to encourage and support medical and pharmaceutical research into illnesses that primarily affect women, with reference to all phases of their lives and not only their reproductive years;
33. Calls on the Member States to solve problems of inequality in access to healthcare that affect people’s everyday lives, for example in the areas of dentistry and ophthalmology;
34. Suggests that the EU and the Member States introduce coherent policies and supportive measures aimed at women who do not work or who hold jobs in sectors where they are not covered by personal health insurance and seek ways of providing such women with insurance;
35. Urges the Commission, in the context of its collaboration with the competent authorities of the Member States, to promote best practices on pricing and reimbursement of the cost of medicines, including workable models for pharmaceutical price differentiation so as to optimise affordability and reduce inequalities in access to medicines;
36. Recalls that the adoption of a European patent, with appropriate language arrangements and a unified dispute-settlement system, is crucial for the revitalisation of the European economy;
37. Notes that the work already done in the Committee on the Internal Market and Consumer Protection with regard to product safety and advertising, among other subjects, has helped to address certain aspects of health inequality in the EU, and, in that connection, stresses the importance of closely monitoring the information which pharmaceuticals firms provide to patients, particularly the most vulnerable and least well-informed groups, and the need for an effective and independent system of pharmacovigilance;
38. Calls on the Member States to adapt their health systems to the needs of the most disadvantaged by developing methods for setting the fees charged by healthcare professionals which guarantee access to care for all patients;
39. Urges the Commission to do its utmost to encourage Member States to offer reimbursements to patients and to do everything necessary to reduce inequalities in access to medication for the treatment of those conditions or illnesses, such as post-menopausal osteoporosis and Alzheimer's Disease, which are not reimbursable in certain Member States, and to do so as a matter of urgency;
