By limiting expenditure for each single production factor (personnel, medical devices, accredited private individuals, etc.) and by contracting investments in technologies and infrastructural renewal, public health will settle its accounts in the short term, but to the detriment of present and future health performance, both that in some regions there is a real risk of undertreatment, i.e. the impossibility of meeting the health needs of the population. By extending payment times, in extreme cases, up to 1.500 days (the average is 236 days for medicines and 274 for equipment) and by not renewing the equipment, companies expose themselves to future costs - and therefore create undeclared debt - in terms of higher prices for supplies, default interest, litigation and personnel employed to meet creditor demands and future technological obsolescence and infrastructural inadequacy.
The 2013 Oasi Report on the Italian health system, presented this morning at Bocconi by Cergas (Research Center on Health and Social Care Management) reaffirms the "sober" nature of our health system, with per capita public expenditure of 2.419 PPP$ (dollars purchasing power parity), significantly lower than that of France (3.133), Germany (3.318) and the United Kingdom (2.747) and a sharply decreasing deficit to 1,04 billion euros in 2012 (- 17,3% over the previous year), which is equivalent to 0,9% of current public health expenditure. The results are notable above all in the regions subject to repayment plans: the deficit of Campania, in 2012, is one tenth of that of 2005, that of Lazio one fifth and that of Sicily is essentially zero. However, the performance gap between the various regional health systems remains significant and the disparity between the regions in the recovery plan and the others is evident "since all and only the regions in the recovery plan (Abruzzo, Campania, Calabria, Lazio, Molise, Puglia and Sicily)", write the coordinators of the Report, Elena Cantu e Francesco Longo, “are in default or partially in default” in maintaining essential levels of assistance. This is a dangerous alarm bell about the potential level of inequity in access to care between the North and the South.
The most penalized expenditure, because it is less rigid, is that for investments, which stands at 59 euros per capita on the national average, but with a strong variability, from 111 euros in Emilia Romagna to 20 euros in Calabria. The southern regions are systematically below the national average, despite having a more fragile infrastructural framework right from the start.
The reduction in public spending is not offset by an increase in private spending, which instead follows the economic cycle and the disposable income of consumers. Also in this case the regional variability is very strong. The Italian average is 463 euros per capita, but it ranges from 707 euros in Trentino Alto Adige to 239 in Campania and the last positions are all occupied by the southern regions. In other words, there is no correlation between private health expenditure and the quality/quantity of public health expenditure. In the richest regions, with the best healthcare, more is spent on paid private healthcare too. This means that the risk of undertreatment becomes concrete in the poorest regions, as already demonstrated by the failure of some of these regions to meet the essential levels of assistance.
Up until now, one of the expedients used to lighten the economic situation of companies has been the lengthening of payment times. The Italian healthcare system, on average, pays for drugs in 236 days and for equipment in 274, with a decrease of about twenty days in mid-2013 compared to mid-2012. The variability is very high and, for equipment, it ranges from 83 days Valle d'Aosta to 929 in Calabria, while for drugs it goes from 75 days in Trentino Alto Adige to 797 in Molise. In general, the most compromised situation is that of Campania, Calabria and Molise, but Piedmont, Puglia and Veneto also need to be monitored. In Campania there are healthcare companies that pay in 103 days, others in 1.509. Regions subject to repayment plans to reduce debt pay, on average, 280 days after the others.
“The recent regulatory measures to liquidate part of the commercial debt accumulated by the public administration”, Cantù and Longo point out, “have certainly improved the situation. However, putting healthcare companies in a position to pay off outstanding debts is not enough. It is necessary for companies to be able to pay punctually even for future ones”.
