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Health insurance covers the entire population of Italy. This encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).
Public vs private
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The national PHR
History
Fascicolo Sanitario Elettronico (FSE), the Italian National PHR, was introduced from Art. 12 of Law Decree 18 Oct 2012 n. 179. The law established that:
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Regional Fascicolo Sanitario Elettronico (FSE) systems must adhere to the national minimum standards for data sharing and basic features. Each However, each FSE is still distinct, with variation across regions, and it is therefore difficult to define a uniform set of features.
The core elements of the FSE as stated in the national legislation include: patient demographics, clinical reports (e.g., specialist visit reports, test results, radiology), A&E reports, discharge letters, organ donation consent, a patient summary, and a pharmaceutical dossier.
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Patient ability to add notes and clinical documents, which promotes self-management and empowerment. Some argue that this should become a core feature.
In-home assistance programs.
Care plans.
Medical certificates.
Vaccination records.
Recent legislation, the Decreto Rilancio (2020), mandates the integration of the FSE with other national systems, including:
The Transplants Information System (Sistema Informativo Trapianti - SIT), a digital platform for managing data related to the National Transplants Network.
The Italian Vaccine Registry.
Regional appointment management systems (CUPs).
Challenges and areas for improvement
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As of the third trimester of 2023, nearly all Italian citizens had have activated their Fascicolo Sanitario Elettronico (FSE), with 57.66 million users out of a total population of 58.85 million. However, login and usage rates remain low.
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In 10 regions (including one autonomous province), no healthcare facilities contributed data to their citizens' FSE.
In six regions, less than 60% of healthcare facilities participated.
Only in four regions did more than 60% of facilities add data to the FSE.
(AGID Agenzia per l’Italia Digitale, 2023-2024).
As of May 2024, the Government has released new statistics on the percentage of Regions and Autonomous Provinces where the FSE is configured to store specific types of documents. However, while the system is capable of storing these documents, their actual presence in a patient’s record depends on the particular healthcare facility involved. All of them are configured to store: discharge letters, prescriptions, referrals, lab results, imaging results, outpatient appointment reports, and emergency admission reports. More than half also have: pathology reports, patient summaries, vaccination certificates, documents attesting specialist care service have been provided, documents attesting the prescribed medication has been bought, and personal health diary.
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