Preventive Medicine and benefit programs in small enterprises in Italy

Introduction:  Since 1994 a large number of new laws deriving from European Directives concerning occupational medicine became compulsory in Italy, where enterprises are mostly small enterprises. For these firms economic and organizational costs to conform to these new laws have been high and frequently have been considered by employers as a tax without   advantages. Little investments have therefore usually been done in not compulsory preventive medicine.    

Methods:  To verify not compulsory preventive medicine activities carried out in small enterprises in Italy in last three years we evaluated 1139 firms having less than 50 workers. For each enterprise we studied if employers organized these programs of benefits autonomously or after an official agreement with workers. We evaluated the role of Occupational Doctors in definition of these benefits and the kind of benefit that have been chosen. We also studied problems eventually found in the different firms in the realizations of these programs.    

Results:  Among the small enterprises evaluated only 221 have activates benefit preventive programs.  In 165 of these firms, programs have been at least discussed with workers, in 56 of them employer decided programs autonomously. Benefit programs more frequently activates have been: not compulsory workers vaccination (mostly against human flu) 22.2%, not compulsory clinical visits or laboratory exams (mostly concerning lipid levels) 45.7%, medical check up (almost all for executives) 26.2%, other programs (no smoke programs, safe drive programs, etc.) 5.9%. Occupational Doctors have been consulted for organization of benefit programs only in 68.3% of firms.    

Discussion:  Preventive benefit programs in small Italian enterprises are not diffuse and frequently not scientifically structured. A more incisive role of Occupational Doctors in promoting and controlling these programs could increase their efficacy in health promotion. A following policy of economic incentive for these programs in small enterprises could surely increase their diffusion.