Gerontocracy and Cronyism in the Italian National Health System

From Top Italian Scientists Journal
Published
June 1, 2025
Title
Gerontocracy and Cronyism in the Italian National Health System
Author
Daniele Focosi
DOI
10.62684/YJKJ6217
Keywords
gerontocracy, cronyism, italian national health system
Downloads
Download PDF
Download PDF

Daniele Focosi

Pisa University Hospital, Pisa, Italy

Correspondence to: Daniele Focosi, daniele.focosi@gmail.com


Abstract

Gerontocracy, the centralization of political power in elderlies, is often a consequence of demographic crises. In particular gerontocracy paves to way to self-perpetuating cronyism, which represents a relevant hurdle against progress in societies. Unfortunately, gerontocratic societies are also prone to suffer from cronyistic health systems. In this manuscript, I dissect evidences supporting the cronyistic state of the Italian health system, their causes oand their dismal consequences on both immediate services to the citizenship and long-term sustainability of the system itself. I finally advocate an urgent reform of selective criteria that focus on objective meritocracy and the introduction of robust term limits.

Declarations

Conflict of Interest

The Author declares that there is no conflict of interest.

References

  1. INDICATORI DEMOGRAFICI | ANNO 2024 - Istituto Nazionale di Statisrtica. Accessed at https://www.quotidianosanita.it/allegati/allegato1743409398.pdf on April 1, 2025.
  2. Statista. Forecasted population in Italy from 2025 to 2050. Accessed online at https://www.statista.com/statistics/573324/population-projection-italy/ on January 9, 2025.
  3. Eisele, F.R. Origins of "gerontocracy". The Gerontologist 1979, 19, 403-407, doi:10.1093/geront/19.4.403.
  4. Catani, S. Gerontocrazia. Il sistema economico che paralizza l’Italia. Edizioni Garzanti. 2014.
  5. European Council . Healthcare personnel statistics - physicians on December 2024. Accessed at https://ec.europa.eu/eurostat/statistics-explained/SEPDF/cache/37382.pdf on April 16, 2025.
  6. Giorgi, C. A history of Italy's health policy from the Republic to the new century. Modern Italy 2023, 28, 1-17.
  7. Fragnito, M. The Medicalisation of Politics or the Politicisation of Medicine: The Case of Italian Struggles to Design Public Healthcare Institutions. DAT Journal 2021, 6, 75-94.
  8. Guarner, J.; Hale, G.L. Four human diseases with significant public health impact caused by mosquito-borne flaviviruses: West Nile, Zika, dengue and yellow fever. Semin Diagn Pathol 2019, 36, 170-176, doi:10.1053/j.semdp.2019.04.009.
  9. Boffardi, R. How efficient is the Italian health system? Evidence on the role of political-institutional dynamics. Socio-Economic Planning Sciences 2022, 84, 101388, doi:https://doi.org/10.1016/j.seps.2022.101388.
  10. Cicchetti, A.; Giorgio, L.; Di Paolo, M.; Daugbjerg, S.; Laurita, R.; Morandi, F.; Tattoli, A.; Villani, L. Sustainability and Resilience in the Italian Health System. The London School of Economics and Political Science 2021.
  11. Taroni, F. Health care policy and politics in Italy in hard times. Journal of Health Services Research & Policy 2015, 20, 199-200, doi:10.1177/1355819615585894.
  12. BBC. Italy's Calabria has two pandemics: Covid and the mafia. 30 November 2020. Accessed at https://www.bbc.com/news/world-europe-55098415 on April 16 2025.
  13. de Belvis, A.; Meregaglia, M.; Morsella, A.; Adduci, A.; Perilli, A.; Cascini, F.; Solipaca, A.; Fattore, G.; Ricciardi, W.; Maresso, A.; et al. Italy: Health system review. Health Systems in Transition 2022, 24, i-203.
  14. “Unhealthy Health System” project report co-funded by the European Commission. Accessed at https://www.againstcorruption.eu/wp-content/uploads/2014/10/Corruption-and-waste-in-the-Healthcare-system.pdf on April 16, 2025.
  15. European Union Agency for Criminal Justice Cooperation. Fraud against Italian national health system halted with Eurojust support. Accessed at https://www.eurojust.europa.eu/news/fraud-against-italian-national-health-system-halted-eurojust-support on April 16, 2025.
  16. Financial Times. How the Mafia infiltrated Italy’s hospitals and laundered the profits globally. Accessed online at https://www.ft.com/content/8850581c-176e-4c5c-8b38-debb26b35c14 on April 16, 2025.
  17. Previtali, P.; Cerchiello, P. The Prevention of Corruption as an Unavoidable Way to Ensure Healthcare System Sustainability. Sustainability 2018, 10, 3071.
  18. Antonelli, M. Corruption in healthcare system during Covid-19. The italian case. 4th General Conference on Organised Crime, Pisa and Online, 4 – 6 July 2022. 2022.
  19. Mail Online. Mafia corruption puts Italian healthcare system in 'state of emergency'. 12 December 2007. Accessed online at https://www.dailymail.co.uk/news/article-501529/Mafia-corruption-puts-Italian-healthcare-state-emergency.html on April 16, 2025.
  20. Lagravinese, R.; Paradiso, M. Corruption and health expenditure in Italian regions. Economic Bulletin 2014, 34, 1498-1511.
  21. Gandolfi, A. A story of the mafia and an inefficient health service. Accessed at https://www.alessandrogandolfi.com/stories/a-story-of-the-mafia-and-an-inefficient-health-service-84 on April 16, 2025.
  22. De Fiore, L.; De Micheli, V.; Brunetti, M.; Ferrante, L.; Rivoiro, C.; Solfrini, V.; Corti, G.; Dirindin, N. An Italian initiative to prevent corruption in health and social care. BMJ : British Medical Journal 2014, 349, g4595, doi:10.1136/bmj.g4595.
  23. Del Sarto, S.; Gnaldi, M.; Salvini, N. Sustainability and high-level corruption in healthcare procurement: Profiles of Italian contracting authorities. Socio-Economic Planning Sciences 2024, 95, 101988, doi:https://doi.org/10.1016/j.seps.2024.101988.
  24. Hoenen, T.; Groseth, A.; Feldmann, H. Therapeutic strategies to target the Ebola virus life cycle. Nature reviews. Microbiology 2019, 17, 593-606, doi:10.1038/s41579-019-0233-2.
  25. La Stampa. Wait list mismanagement reveals corruption in Italy’s public health care system. January 19, 2018. Accessed online at https://www.lastampa.it/esteri/la-stampa-in-english/2018/01/19/news/wait-list-mismanagement-reveals-corruption-in-italy-s-public-health-care-system-1.33969346/ on April 16, 2025.
  26. The Lancet Regional Health –, E. The Italian health data system is broken. The Lancet Regional Health – Europe 2025, 48, doi:10.1016/j.lanepe.2024.101206.
  27. Fassin, Y. The ha-index: The average citation h-index. Quantitative Science Studies 2023, 4, 756-777, doi:10.1162/qss_a_00259.
  28. Bermingham, A.; Chand, M.A.; Brown, C.S.; Aarons, E.; Tong, C.; Langrish, C.; Hoschler, K.; Brown, K.; Galiano, M.; Myers, R.; et al. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2012, 17, 20290.
Retrieved from ‘https://journal.topitalianscientists.org/index.php?title=Gerontocracy_and_Cronyism_in_the_Italian_National_Health_System&oldid=2224’