Following the six-month European presidency of Italy, the competent Ministers of the various European countries are convened in that country to discuss the various aspects of Farming, Transport, Labour, Foreign Affairs, Treasury, right up to National Health Services.

But what do the various systems of the fifteen countries belonging to the E.U. have in common? And what do the national health systems of France, Greece, Italy, Denmark, Belgium, Ireland and Portugal, without mentioning the other countries of eastern Europe about to enter Europe, have in common? And what relationship exists in all the E.U. countries between the National Health Service and private health services? But above all, what sort of services do the national health systems of the various countries provide and how are these funded?
In the wake of indispensable checks on public expenditure that enable us to comply with the famous Maastricht parameters, the sector continues to undergo changes in all the countries to try and harmonise the different health services before the launching of the new European Union Constitution, which ought to ensure the same rights and obligations for all the Citizens of the Union.
But finding a common denominator for all European health systems is not easy, especially when the stage is packed not only with those charged with running such systems but also with the persons in charge of Economy, Welfare, ecologists, environmentalists and lots of others all anxious to have their say. To start with, there is the problem of funding.
Some health systems are funded by taxes and composite systems, others by insurance schemes and only partially by taxes. Currently, those health systems funded by taxes continue to be downsized by the various Financial Laws, while integrated systems are criticised because they are said to be too costly.  Then there is the big problem of understanding how health systems can be better harmonised which are based on a philosophy of state intervention in the health sector that varies considerably from one country to another.
Those countries that implement a mixed system, for instance, have as their basic philosophy a coverage of the health risk, a typical insurance concept and one that forces individuals to contribute to the cost of the Service by paying health contributions determined on the basis of the risk covered.
Different is the case of those countries which have at the bottom of state health intervention a health protection concept that also includes in the Health melting pot programmes of public utility in the field of Hygiene, preventive medicine, accident prevention and agri-food protection, all aspects which, though part of a concept of illness or accident prevention, lie beyond the real expenditure the Service has to sustain for diagnosing and curing illnesses suffered by individuals who have actually contributed towards paying the services which ought to be related to the benefits provided.
This is why the current systems of the various European countries are not easily comparable and, above all, cannot be harmonised. In Italy, for instance, the National Health System is funded by taxes only, something that makes impossible a correct relationship between the taxes an individual pays, the expenditure for health services provided to the taxpayer and the actual obtaining of valid cures by the paying individual. Because of course, let it be very clear, it is always the individual who pays for the service that the State continues to say is too costly and reduces year after year. Saving measures have in fact resulted in expenditure for health services in Italy being among the lowest in western Europe.
But what is the situation in the other countries? In other countries with deep-rooted democracies, mixed systems operate. These are systems whereby health services are funded mainly by insurance companies and only to a minor extent by the State.
The insurance companies in turn collect premiums or income percentages, with costs shared out between employees and employers (as is the case of Germany and France) or amounts paid directly by families (as in Switzerland) or again, using a mix of both systems, as in the Netherlands.
In these countries therefore, the insurance companies collect larger resources. It follows that, in these countries, the possibility exists of providing health services more in line with the actual cost of such services and therefore of better quality, precisely because all the contributions made are directed towards the diagnosis and curing of illnesses.
The choice at European level cannot therefore ignore the indispensability of entering the very composition of health expenditure in order to first of all harmonise collection systems and then optimise the relationship between contribution and service. The Italian Minister of Health, Girolamo Sirchia, says it is “crucial to also introduce into Italy ways of controlling health costs”. It is also essential, according to Sirchia, to better organise relations between state and private spending.
‘ ’Already today - said the minister - we need to find private resources because the National Health System cannot increase its own ad infinitum. Currently such funds are dispersed in a thousand different ways while they should be directed through more specific channels”.
Our country too will therefore have to find a way of distinguishing between services of a general nature for protecting the health of the entire population, to be correlated to taxes, and those related to the diagnosis and cure of illnesses of the individual persons who use the Service, which must be tied to an insurance payment concept in order to make the bond between contributions paid and services rendered more realistic.

Translated by interpres sas