AS the United States reforms its private health-care system, Italy's largely state-run program is facing its own day of reckoning. Yet the central issue here is not cost, but corruption.
The Italian system, critics charge, has for years favored the interests of doctors, political parties, and the pharmaceutical companies. It has become so indifferent to patients, they say, that an operation can take months or even a year to schedule. Those who can afford to do so go abroad.
In the latest development, Rome judges launched a probe last week into allegations that human organs were secretly removed from corpses and sold on the black market to patients awaiting transplants.
Earlier this month, Italians who had had blood transfusions between 1985 and 1987 have been advised to be tested for AIDS, since controls were allegedly suspended by Italian health officials during that period. For the same reason, investigators say, hepatitis-infected blood may have been used from 1985-91.
``We don't know - and we have to find out - what damage was done,'' says Teresa Petrangolini, a health crusader for the Democratic Federative Movement.
The story began unfolding this summer when investigating magistrates focused on influence-peddling in the health-care community. A medical professor at the University of Naples committed suicide in July after writing a memoir about how kickbacks were allegedly collected from pharmaceutical companies by his boss, former Health Minister Francesco De Lorenzo.
Concerned that he might tamper with evidence, judges presented Parliament with an 800-page dossier against Mr. De Lorenzo and called for his jailing (as a parliamentarian, he cannot be arrested without the approval of his peers). Parliament, hundreds of whose members are themselves under investigation in the country's ongoing corruption scandal, dragged its feet until September and then turned down the request.
IN recent weeks, Duilio Poggiolini, the director of pharmaceutical services in the Health Ministry since 1973, has been imprisoned and interrogated in connection with the kickbacks, which were allegedly paid to put medicines on the market, to keep them there, to broaden the circumstances under which they could be prescribed, to inflate prices, to get state permission to double certain prescribed dosages to boost sales, and so on.
With the arrest of Poggiolini and the whole De Lorenzo affair, very grave facts came to light, which demonstrated the need for a deep change in the pharmaceutical and health system,'' says Ivan Cavicchi, the coordinator of the health sector of CGIL, Italy's largest trade union. ``This reform will obviously go up against very great interests.'' Mr. Cavicchi wants Italy to join other European countries in introducing a state-run pharmaceutical supervisory board to check the effects of medicines.
Meanwhile, large kickbacks appear to have been paid. Following police searches of Mr. Poggiolini's homes, which revealed some 60 paintings and billions of lira hidden in a sofa, Poggiolini reportedly volunteered to return 11 billion lira ($6.5 million) and De Lorenzo 4 billion lira.
``That there was corruption, I think everyone knew by now,'' Mrs. Petrangolini says. ``But, quite honestly, it was difficult to imagine that it was at those levels.''
``We're working so that the Italian citizens will become ever-more-active citizens and that they will assume the responsibility, not only in reporting abuses, but also in rebuilding. It will take years.''