The adjective ‘subsidiary‘ derives from the Latin subsidiarius, which in ancient Rome indicated the rear guard of the army. Only later did the word take on the meaning of ‘reinforcement’, ‘relief’. This etymology highlights the logic of integration, but nevertheless hierarchy, that the word implies: the reserve complements the army, but is not the first choice or the most important element at the start.
In contrast, the noun ‘partner’, having passed through Old French, comes from the Latin pars, meaning ‘part’ or better still ‘party’. The logic behind partnership is, therefore, a logic of division but equality: two distinct but equal elements cooperate for a common end.
From these brief etymological observations, it is clear that subsidiarity and partnership are two valid models of organisation, each with its own merits and flaws. And in the case of Italian healthcare, the two models are often invoked, now by the public and now by the private sector, to celebrate or denounce this or that situation.
Article 32 of the Italian Constitution states:
The Republic protects health as a fundamental right of the individual and interest of the community, and guarantees free care to the indigent. No one may be obliged to undergo a given health treatment except by provision of law. The law may in no case violate the limits imposed by respect for the human person.
Its development is Law 833 of 1978, where the three principles are laid down: universality, equality and equity. The entire population has the right to access the services of the National Health Service, without distinction of individual, social or economic conditions. What emerges is that the State is the guarantor of everyone’s right to health and that all public or private entities affiliated with the NHS are charged with a social responsibility towards citizens.
It is precisely in this space, between the State and the Market, between the public and the private sector, that the so-called third sector is located. Those entities stand alongside the public and the private, interacting with both in the interest of the community.
Whatever the actual relationship between public and private may or should be, what must be guaranteed (and protected) are universality, equality and fairness. And since it is the state that is the guarantor of these fundamental principles, it seems logical and necessary that the role of planning and quality control of the services provided should be maintained by the public. At the same time, however, as the pandemic has tragically demonstrated, the public does not have the means to take on all the demand. The private sector has neither a subsidiary nor an equal role vis-à-vis the public. The private sector is subordinate to the state, its principles and its laws, of which it is a part of the public, but it is (or could be) concomitant with the public in the production of health services.
What word would best express your feelings about the relationship between public and private healthcare?
