ROME (ITALPRESS) – Italy respecting macro-economic compatibilities (and therefore considering interest on public debt and also the country’s level of development) could spend 19.9 billion euros more (+11.3% of current funding) on healthcare.This is a figure far from the real funding possibilities, considering that other spending chapters, first and foremost education, are also still underfunded.In any case, this increase would not even be enough to align the staffing, and related salaries, with the average of other European countries. At least 30 billion euros would be needed to cope with staff shortages, and, in order to align beyond staffing the salaries of professionals with the standards of other countries, it would be necessary to double the overall burden.As proof of this necessity, to meet health needs the Italian population spends privately ‘officially’ 41.4 billion euros a year on health care, more than 23 percent of which is spent by poor families who, if it were not for real needs would really do without this burden. And the bills would certainly be even higher considering that 3.4 million households claim to forego health care consumption and 1.2 million actually zero them out.Today, Italy is the richest of the poorest countries when it comes to health care, and if the promises made through reforms over the years and laws that have changed the organization of care are to be kept, precise, even politically uncomfortable, choices are needed.The figure is from the C.R.E.A. Health Report ‘Maintenance or Transformation: public intervention in health care at the biviò (downloadable at https://www.creasanita.it/scientific-activities/health-report/), presented at the headquarters of CNEL (for which C.R.E.A. Sanità curates analyses on the functioning of public administration for health aspects) in Rome.And debating the highlighted evidence are for the first time six former ministers of Health/Health, who have succeeded at the helm of the NHS over the past 30 years, to address the discussion based on the evolution they themselves have given to the Health Service, also in a political, but nonpartisan way (for this, the last two ministers of Health are not involved).The C.R.E.A. Report. Health also provides the cross-section of the current situation on the main items that make up the picture of national care by analyzing it from a socio-health perspective (demographics; financing; cross-cutting networks including digitization, staffing oncology networks; prevention performance indicators; evolution of hospital care; residential care, outpatient specialty care; drugs and medical devices; home services; screening; mental health), to take exact stock of the economic – and other – problems of the sustainability of the system.In C.R.E.A. Sanità’s analysis, which makes the exact point from which to rethink the system, there are then international comparisons and, at the national level, a Region-by-Region focus of the positive and negative results that characterize them, and the Report also compares the results and effects of choices in the last three three years of health management.A ‘guiding’ aspect is that of equity, on which the Report points out, among other things, that the financing of the system itself is concentrated on less than 20 percent of the population and the remaining 80 percent pays less than the value of health services that (on average) they receive from the state: ‘An exaggerated inequality of incomes at the national level,’ the Report states, ‘with consequences in terms of sustainability, given that the public health service economically weighs on the shoulders of a very small share of the population.The imbalances in the system do not end there: in financing, the regional standard requirement differential is within a range between minimum and maximum per capita of about 150 euros. In parallel, the range in which the differences in private expenditures at the regional level are placed is 471.8 euros so 3 times that of the standard requirement and 1.4 times that of the actual financing.All this, of course, has its effects on spending: a continuous departure from international average levels is confirmed; compared to a per capita GDP 19.7 percent below the average of EU-Ante 1995 countries, public health spending is below average by 44.1 percent (gap growing by 1.2 percent compared to 2022 and 11.4 percent over the decade), and private spending by 8.7 percent (gap growing by 2.3 percent compared to 2022 and down by 12.0 percent compared to 2013).Although current NHS funding has reached its highest level ever, dividing the time horizon into three two-year sub-periods (pre-pandemic 2019-2021, pandemic 2020-2021, and post-pandemic 2022-2023), the Report finds in the first period a real increase of +1.6%; in the second, +3.4%; and in the third, it is negative (-4.9%).Turning to a comparison based on a statistical analysis of the relationship between countries’ resources (GDP per capita, net of interest on public debt, which is unavailable for financing Welfare) and per capita health spending, Italy’s health spending is below the expected level of 11.3 percent.The transformation has one main objective: to make the Service capable of realigning ‘promises’ with available resources, avoiding implicit rationing that is by definition an object of injustice because it penalizes the most fragile population, in terms of health but, even more so, of census and health literacy.To achieve this goal, public intervention must broaden its boundaries, giving up entrenching itself in the idea of a hegemonic position of the public service, dealing with the governance of the entire health care system, including the (significant) share of health services now classified as private health care.To rationalize, it is first necessary to open a debate on the principles to be inspired by: among the options that can be debated is that of acting according to the clinical/assistance severity of needs (prioritizing the most severe diseases), or according to the merit of responses (prioritizing interventions with greater therapeutic value or social value). Or again on the basis of barriers to access (prioritizing the needs of the less affluent and/or the less ‘health literate’).’Having a vision implies priorities,’ the Report states, ‘and giving them to oneself implies, by definition, making politically ‘uncomfortable’ choices: a consideration that leads to the assertion that there is a need for super-partisan sharing on the adjustment of the principles of public intervention (governance) in Health Care, which avoids the risk of Health Care being the object of mere party clashes.To support all this, C.R.E.A. Sanità provides in the Report a starting point for a political discussion on the issue, investigating among NHS stakeholders the ‘value’ and the actual ‘declination’ attributed to certain principles.To do so, it promoted a survey among the members of the Expert Panel of the study ‘The Regional Socio-Health Performanceè (2024)’, who represent the main categories of NHS stakeholders: patients, health professionals, health management, institutions and industry.The survey focused on issues that can be ‘divisive’ and opinion was asked on five principles: Equity; Subsidiarity; Appropriateness; Public Service; Supplementary Benefits.The results confirm different views on the founding principles of the Service, which also depend on the different nature of the stakeholders.For Equity, emphasis was placed on the economic aspects of access, as well as equity on the financing side, in a perspective of rationalization/prioritization of interventions, the question of the credibility of the fiscal system emerges: a universalistic Welfare that cannot rest on a credible ‘proof of the middle’ is at risk of being completely unfair and, therefore, socially unjust.On Appropriateness, the consensus converges on adherence to the Guidelines, integrating the principle of economic efficiency in delivery. The aspect of patients’ differing eligibility for services based on their socioeconomic characteristics, for example, is poorly perceived as discriminatory.-photo press office C.R.E.A. Sanità -(ITALPRESS).
