With an incidence on GDP of 8,9%, Italian health expenditure came close to 2016 billion euros in 150, a level that affects public finance choices and creates alarm over the sustainability of the national welfare system. Complete information on its extent is therefore essential to evaluate the consequences of the progressive aging of the Italian population, which can affect both the level and composition of assistance.
Of particular importance is the assessment of the resources absorbed by long-term health care, which is the one that should be most immediately affected by the increase in life span and the increase in the number of very old people. The health expenditure structure also provides key elements for evaluating the direct impact on various sectors of activity, which include, for example, the pharmaceutical industry, the production of therapeutic devices, hospital and outpatient care, rehabilitation and assistance services long-term.
In Italy, the role of the public administration and compulsory insurance is preeminent
Despite its undoubted relevance, however, it is not easy to obtain consistent information on the level and composition of health expenditure. Furthermore, it is difficult to find data on the sector's performance in other countries that allow for comparisons. To make up for this situation, an international project on healthcare accounts has been developed which aims to offer comparable data on current healthcare expenditure by funding regime, by care function and by provider.
The analysis of health expenditure by funding regime confirms that in Italy the role of the public administration and compulsory insurance is preeminent, which in 2016 covered 75% of expenses, while households and voluntary insurance covered the remaining 25%. Instead, what perhaps contrasts the consolidated image is the fact that the share of public sector financing is lower than that of the main European countries such as Germany (84,6%), France (78,8%), the Netherlands ( 80,8%) and the United Kingdom (79,2%). In these countries, however, the largest share of public financing of health expenditure is supported by compulsory insurance and the role of the public administration is marginal. Only the United Kingdom presents a situation similar to the Italian one.
Expenditure concentrated on hospital and outpatient care and medicines
In Italy, health expenditure is concentrated on three main functions: ordinary hospital care (28,0% of the total in 2016, 42 billion euros), outpatient care (22,4%) and pharmaceutical products (17,8 %). Between 2012 and 2016 there was a significant recomposition of health expenditure, with ordinary hospital care decreasing by -3,8%, outpatient care increasing by 9,2% and spending on pharmaceutical products by 11,2 ,10,1%. Long-term healthcare, which is often a source of concern, still has a limited share (2016% in 16,3), lower than that of several European reference countries (in Germany it is 18,2% and in the United Kingdom United at 3,9%) and presents a moderate trend in recent years (3,5%) just above that of overall health expenditure (XNUMX%).
Health assistance is mainly provided by hospitals (45,5% of expenditure, equal to 68 billion), by clinics (22,4%, 33 billion) and by pharmacies (16,7%, 25 billion). Hospitals have a rather high share of healthcare expenditure also in international comparisons: among the main European countries, only the United Kingdom (41,8%) and France (40,2%) have comparable shares, while Germany (29,2 %) has a lower share. The role of pharmacies in the delivery of health care fluctuates greatly between European countries; Italy is in an intermediate position between Germany (19,5%) and France (18,9%) on one side and the Netherlands (12,2%) and the United Kingdom (11,5%) on the other.
The health accounts allow further analyzes on the levels of per capita expenditure and on the incidence of health expenditure on GDP. Overall, the analytical information now available seems to indicate that the perception of excess health spending is not confirmed by aggregated data, but needs to be qualified with more in-depth analyzes relating to specific types of assistance.
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