Image Analysis Techniques

Health as a Private vs. Collective Good

The concept of health was long seen as a private concern with institutions only intervening for basic hygiene and infectious disease prevention.
Traditionally, health protection relied on private initiatives and religious groups.
The evolution of the healthcare system mirrors a country's social and political development.
Over time, legal advancements have gradually shaped health perception, leading to today’s healthcare setup.
The constitution recognizes health as an inviolable right, fulfilling the population’s needs; health is a human right, not a privilege.

Ancient Hospitals

In ancient Rome, the "pater familias" cared for their family and slaves, passing down medical knowledge.
Julius Cesar enacted a law creating the first medical schools, where both theory from Greek texts and hands-on practice like checking pulse and symptoms were taught.
Discretion, a low voice, and a smile were desired traits for medical practitioners.
Medical examinations were thorough, including palpation, urine/feces analysis, and chest auscultation.
Doctors who visited patients at their bedside were known as "clinicians".
"Hospitals" were workshops, similar to those of artisans, acting as clinics, first aid stations and providing private care after surgery.
Doctors prepared their own remedies: ointments, infusions etc.
Health care evolved from home remedies to organized care in "valetudinari", "medicatrine" and temples.
Valetudinaria were private buildings or gyms employing doctors, nurses, and midwives.
Mediatrices were Tabernae medicorum around 290 BC which consisted of laboratories or patient lodgings in a doctor's home.
In 292 BC temples were used as hospitals due to a plague in Rome, such as the temple of Esculapius on Tiber Island, now Fatebenefratelli Hospital.

Ospedale Etymology and Early Christian Influence

The word "ospedale" originates from the Latin "Hospes" (guest) and is related to hospices, hospitality, and hostels.
Hospitals and hospices became more common with Christianity, focusing more on charity than healthcare and included the poor and pilgrims.
These churches with a welfare role were called "diaconies," which means "churches of service.".
Eastern Christian hospitals varied in function: xenodochia for foreigners, nosocomi for the ill, ptochia for the poor.
Hospitals were often in monasteries or churches; new constructions mirrored church designs with an altar at the end.
Placement of patients reflected severity; those less likely to survive were closer to the altar for prayer.
Early hospitals included S. Basilio of Cesarea (372 AD), Porto in Rome, Hotel de Dieu of Lyon/Paris, S. Spirito of Rome, and the infirmary of San Gallo in Switzerland.
Shelters were established along pilgrimage routes by figures such as S. Bernardo da Mentone.
Religious orders like the Hospitallers, Knights of Malta, S. Lazzaro, Templars, and Teutonic focused on caring for the sick.

Medieval Medical Care and Specialized Orders

Monasteries became medical centers where studies, knowledge, and ancient texts were preserved.
Hospitals were created by these orders, as demonstrated by the Order of Saint John in Jerusalem
The order of San Giacomo d'Altopascio, founded around 1080 near Lucca, offered hospitality and protection to pilgrims traveling to Rome
Antoniani cured ergotism, known as Saint Anthony's fire and Lazzariti treated leprosy.
The order of Santo Spirito was created by Pope Innocent III who directed the Roman hospital of Santa Maria in Sassia, and cared for abandoned children

Evolution of Hospitals Through the Ages

Medieval hygiene was lacking with grave epidemics decimating populations, such as the plague in Messina (1347)
Plague led to demolishing infected houses, quarantines, and creation of lazarets.
Around the 13th century, there were approximately 19,000 hospitals in Europe.
The late Middle Ages and early modern era saw the rationalization of the assistance network, cities established major hospitals, uniting expertise.
Milan's Ospedale Maggiore ("Cà Granda"), built in 1456, exemplified a new functional hospital concept.
Infirmaries built above basements had forty beds along the walls.
Corridors with running water and latrines were made accessible between beds.

Hospital Conditions and Early Reforms

Patients shared straw mattresses, with three large, four medium or up to six smaller people per bed.
Select patients were allowed to have single beds; it was initially opposed, later allowed for 50 scudi.
Hospital employees, epileptics, and the mentally impaired were offered free single beds.
Non-privileged patients shared beds, half resting from 8 PM to 1 AM, the other from 1 AM to 8 AM.
Syphilitic patients were whipped before entering and upon leaving according to admin order.
Cicognini noted, in 1759, that rotating patients in beds created several problems and caused a lack of respect

Towards Modern Hospital Concepts

Cicognini promoted dividing patients by illness (fevers, wounds etc) and separating children from adults.
There was also call for separating simple cases from acute/contagious ailments, and women on the basis of their maternity state.
In the 1700s Europe was coming to the realization that a real hospital should be a structure one could go to without fear.
Hospitals transitioned from asylums to means of social defense in Europe.
The 17th century hospitals became medical and surgical schools.
The 18th century hospitals were inadequate in terms of hygiene and capacity, pavilion-style hospitals emerged in England, France, Germany, and later in Italy.
New structure enabled to differentiate buildings and function , with specific buildings set aside for contagious diseases with improved exposure, aeration, and light conditions.

Modern Healthcare System Development

The modern National Healthcare System (SSN) reflects evolutionary shifts in contemporary European and global societies.
Healthcare shifted from charity to an insurance-based and ultimately a right-to-health system.

Concepts in Healthcare Systems

Beneficence involves a health system based on private and voluntary care.
Assistance is when the State cares for the health of individuals who are in conditions of proven and official poverty.
Mutual aid means that the health and economic needs in the event of illness are covered by a voluntary fund in a determined and limited fashion.
Social insurances means is when the State funds particular entities created on the premise of the assumption of labor.
National health services imply that Healthcare is directly assumed by the State with services directed towards the health of all citizens.

20th Century Healthcare Development

State organizations gained sophisticated structures, focusing on collective efforts to cut disease and mortality rates.
Great bacteriological discoveries, along with a widespread distribution of hospitals, necessitated the start of a National Healthcare System.
A hospital is a place where the unhealthy were taken in.
A recovery implied a place where the unhealthy waited to be taken care of.
Patients used to stay a long time in clinic given the settings being convents with the remedies in development.
Napoleon instituted the first centralized system for public health, where the prefecture was the basic unit.
In May 1798, Napoleon Bonaparte conquered Italy, and installed in the same month the General Administration of Lombardy which was under Francesco Melzi d'Erl.

Towards a Unified System

In 1803, Melzi’s republic suppressed clientelism by centralizing Lombard hospital administration under government-appointed officials.
In 1807, in all departmental capitals, the administration of hospitals, orphanages, and public charities was consolidated into the Congregation of Charity.
French legislation influenced Italy, transferring authority over public welfare to the Minister of the Interior and creating the concept of domicile.
In 1814, Rome sought to restore old methods, yet maintained the consolidation of hospitals grouped into divisions: hospitals for the sick, hospices for the old, and conservatories for youth.
Industrialization mechanized labor and uprooted rural workers who were living in poor hygienic conditions.

Limited in the initial 1800s were factory collections, where a mutual aid fund was created with a manager appointed by the owner or a foreman to care for illnesses.
A lack of labor law and employee rights prevailed.
In the late 1800’s, strikes and rallies led by the socialist party lead to labor laws and worker protection.
In 1900, the National Congress for Insurance was held in Italian mutual aid societies in Milan.
Antonio Maffi proposed a joint organization among mutual aid societies to safeguard the autonomy promoting general mutual interest
As a result, in 1912, what is now know as the Federation of Mutual Aid Societies is founded to address welfare manifest in 800s society.
They subsidized diseases or death with payment of small installments and guaranteed assistance for indigents given there was zero state welfare present back then.

Mutual Aid Societies and Healthcare in the late 1800s

In 1882, mutual aid societies supported welfare through legislative design by Minister Domenico Berti
N. 3818 law was approved in parliament in 1886, and remained in valid form to the modern era and a blood repression the government put out an enciclical Rerum Novarum with catholic mutual aid
Those that wished to multiply with such presence and apostolate had to refute the marist theories.
Despite of such strong divergences some were unanimous in the state regulation that did or did not work.
800 Italian union was one of radical disease

Healthcare Law and Health

Law of 1865 put responsibility on public health but didn't include responsibility over sea and land.
Healthcare law that implemented administrative power had too much red tape was too slow, it was not efficient or effective.
In 1888, small pox vaccination is necessary and mandatory
In 1900, asylums rose to handle people spreading disease
In the 1930s-40s voluntary aids rose, but would eventually become mandatory
There was therefore no actual insurance for the citizens or employees

Healthcare System Leading to Change

From WW1 to 2 the aid societies rose more, for professional protection only to select people
Insurance is related to citizen or family, there will inevitably be the condition and cost for each area

Post-WWII Healthcare Development

After World War II, the Republic's new Constitution explicitly established the right to healthcare for all.
The Constitution states that it is the Republic's duty to protect health as a fundamental right.
Care must be granted for indigents free of charge through the state.
In 1958, the Fanfani II government established the Ministry of Health for the first time in Italy.

Modern Revisions and the Role of the State

In 1968, the Mariotti law reformed the hospital system, turning assistance and charity entities into public bodies.
As such, national and regional programming would be funded by law.
In 1974, the law n. 386 paid the public debt of clinic, and regions took hospital management.
A big change to clinic such as that of asylums to be more safer for a patients.
In 1978 law n. 833 the mutualist system was suppressed of the national sanitaria.
To carry this out, the constitutional principals include
State gives power and help
Every citizen must help to bring the health of citizens to a satisfactory state

The Universal Health System

Health protection is directed to all members of the community.
Fees are charged at General Taxation.
Principles of the national health system include
Universality in that treatments can be provided to everyone
Equality in that everyone is entitled to the same pay and treatments
The global is every service with rehabilitation
There was 1993 goal for hospital to have great pay

Current Structure and Future Considerations

Useless as there will never be sufficient funds for the new facilities
1992 there will have to be a new hospital given poor system
The hospitals are private and it may harm the future.
12 GEN 2017 - all levels to have treatment by the hospital

System Elements

Services are allocated to all patients in public with money from tax
Now you don't need to give money directly as the law is now quantity based, and not quality based.