The Camera has unanimously approved the proposed law extending healthcare to homeless people, put forward by the Partito Democratico and sponsored by Marco Furfaro. Without exaggerating, this is a measure of great importance, one that fills a gap that had excluded thousands of citizens — among the most fragile and vulnerable in the community — from one of the most fundamental rights: the right to health.

In practical terms, this is a pilot scheme that will run for two years, from 2025 to 2026, and will initially involve 14 metropolitan cities: Bari, Bologna, Cagliari, Catania, Florence, Genoa, Messina, Milan, Naples, Palermo, Reggio Calabria, Rome, Turin and Venice. The allocated budget is 2 million euros, intended to cover more than 60 per cent of homeless people in the country. A good start on a serious and important issue that has never previously been addressed in concrete terms.

The right to health currently denied

At present, a homeless person in Italy, owing to the lack of a registered address, is excluded from the national health service. This means that anyone who falls ill can only turn to the emergency department, which cannot refuse treatment. But we know all too well what the situation in emergency departments across the country is like. And beyond that: where can medicines be obtained free of charge? Where can tests and check-up appointments be carried out? For those living on the street, for a wide variety of reasons, there is currently only one solution: third-sector organisations (Enti del terzo settore, or Ets, as non-profits are now called) that provide medicines and medical consultations free of charge at their urban or mobile clinics.

Supply, however, falls well short of demand. It is therefore of fundamental importance to restore the right to health to tens of thousands of homeless people — more than 96,000 have been counted, 62 per cent of them Italian nationals. It should be noted that these figures are entirely indicative and do not accurately reflect the real population of people living on the streets: they are difficult to count precisely, and however hard local authorities try — for example, Milan recently organised a "Raccontami" census of homeless people with the help of numerous volunteers — knowing the exact number is a utopian goal. In the Lombard capital, thanks to this project, 2,343 people were recorded.

It is worth recalling that articles 3 and 32 of the Italian Constitution enshrine respectively the right to equality and the right to health. Furthermore, the national health service, established in 1978, provides healthcare for everyone, without distinction of individual or social circumstances.

A GP for homeless citizens too

The law approved by the Camera provides for the introduction of a GP for homeless people through registration in the records of the local health authorities (Asl), a process that will be carried out with the assistance of associations. It remains to be seen how this procedure will be organised and, above all, how it will be communicated to these vulnerable categories of citizens. This measure represents, first and foremost, an act of social justice, but also an economically advantageous intervention. Currently, each visit to an emergency department has an estimated average cost of between 250 and 400 euros. With the assignment of a GP, the annual cost per person would drop dramatically to around 70 euros, covering 80 per cent of these people's healthcare needs and easing pressure on emergency departments.

There are, however, many challenges — there is no point in hiding it. Chief among them is the shortage of GPs across the country. A great many cities, such as Milan, report GPs who are overloaded with an excess of registered patients and consequently have little time to devote to each one. How will it be possible to add even more?

There are, however, regions that are already getting it right, and studying their best practices could prove useful. Emilia Romagna, Puglia, Abruzzo, Liguria and Marche already have regional legislation guaranteeing a GP to homeless people (those without a registered address). Piedmont, in 2022, instead introduced the figure of the socio-healthcare tutor, whose role is to support these citizens in accessing socio-healthcare services.

The case of the Poliambulatorio of Opera San Francesco in Milan

At present, homeless people who fall ill either go without treatment — which is the case the vast majority of the time — or turn to third-sector organisations. In Milan, where the number of people in acute need is large and continues to grow, Opera San Francesco is one of the organisations that assists citizens living in poverty and difficult circumstances. It is not the only one, but it is perhaps the one with the highest number of visits and the longest history, and we mention it because the author of this article has personal and professional experience of it.

Its Poliambulatorio was founded over 25 years ago, precisely to guarantee free medical care and medicines to those who have no entitlement to the national health service. Its patients are mainly foreign nationals, but increasingly also destitute Italians and homeless people. The scale of the assistance provided speaks for itself through the figures: in 2023, an average of 111 consultations per day were provided free of charge — a total of 26,000 services to more than 7,100 patients — all thanks to the voluntary work of over 220 doctors. An enormous number of people, which is a testament to the situation in Italy's major cities, where hardship is most prevalent. The measure is therefore absolutely worthwhile and is a good starting point for addressing an issue that has never sat at the top of the Italian political agenda.