The Italian National Health Has Balanced Its Books. It Therefore Has to Change!
In 2013, public spending on health has declined, for the first time in nearly 20 years, both in absolute terms (the spent 112.6 billion representing a decrease of 1.2% compared to 2012), both in relation to GDP (from 7.3% to 7.2%). The deficit was reduced to about 1% of current expenditure and indeed, if you account for the additional income tax collected in the year following the shelf of the deficit of the previous year, you can even account for a surplus of 518 million in 2012 and 811 million in 2013.
In highlighting these data, however, the OASI Report 2014 from CERGAS and SDA Bocconi in collaboration with Bayer, presented today in Milan, highlights the road that remains to be traveled.
"The health care companies," stated the editors of the report, Elena Cantu and Francesco Longo, "have performed a minor miracle: a balanced budget, and no increase in spending for 5 years with overall stability of the system despite the aging of the population, worsening epidemiology, new technologies and increased poverty. The system is now fully sustainable. From the stage of strong expenditure restraint with input based structure ", continued," we must now reorganize services in alignment with emerging epidemiology: a job for the medium term, now possible because we have put the accounts in order. This is the challenge facing the NHS, and healthcare companies must play a central role."
The process of improvement in the accounts is not, however, without costs. The national health system has reduced the personnel costs by about 1.5% per year over the last three years by not replacing those who retire, wage are frozen s and many activities outsourced to social cooperatives. In the Tyrrhenian regions subject to repayment plan (Lazio, Campania, Calabria and Sicily), the permanent staff was reduced by 15% from 2006 to 2012 and that in time and temporary staff by 27%. The dynamics of the pharmaceutical expenditure was, if possible, even more marked: it decreased by 7.6% per year over the past three years.
The spending restraints include forms of rationing, such as waiting lists or caps on benefits provided by accredited private companies. Because of these constraints, these private supppliers are in working, on average, just over 70% of production capacity, with obvious threats to their economic equilibrium. More generally, the entire private health sector is affected by the cuts. In Italy it employs more than 110,000 people and more than 60% of national health system funding pours into it.
Italians have begun to treat their health as a luxury item. The costs in the luxury goods are the first to be cut when reducing the purchasing power and spending in health has followed this same curve in recent years. The lower government spending is not, in fact, replaced by higher private spending, which indeed decreased by 1.5% in 2012 and 5.3% in 2013, despite the sharp increase in co-payments. If the total amount of co-payments has remained more or less stable until 2007, since 2013 there has been a doubling, from 1.6 to 3 billion Euros, due to the introduction of the so-called "superticket" co-payment for specialist care. The increased expenditure for co-payments was, however, more than offset by the decrease in other private expenses. Moreover, in the aftermath of the introduction of supertickets, the claims for benefits have decreased.
In the current economic climate, concludes the report, the investment capacity of the national health system has been greatly reduced, and is now equal to 5% of current health expenditure. If, today, the OECD welcomes the situation of the Italian healthcare technology, it is clear that the data suggest uncertain prospects for the future.
"The results of this study by CERGAS Bocconi allow us a glimpse into the future scenarios of our healthcare system. They help us to interpret the change in place thanks to investments in innovation that lead over time to the development of new therapies to be used according to the principles of appropriateness", said Giovanni Fenu, head of Bayer Pharmaceutical Division Italy. "In line with our mission, we want to contribute to the development of a health system that is sustainable and that allows access to more and better health care for citizens. It should also give patients the opportunity to benefit from the new possibilities of care regardless of their geographical-regional context. These objectives are now closer, thanks to the growth of the crucial dialogue between health professionals and citizens. Both items should always be interpreted as a fundamental opportunity for listening and reflection for all those who are engaged in finding improvements and sustainable healthcare solutions".