Private health care out of pocket (out of pocket) continues to grow in Italy, as certified by the national public accounts system. According to Istat (source: The healthcare accounts system for Italy, 2012-2016) in 2016 it was 33 billion and 930 million, equal to 22,7% of current health expenditure and 2% of GDP. The trend in recent years is growing, with rates between + 4,5% between 2015 and 2014 and + 0,4% between 2016 and 2015. Compared to the types of assistance, again according to Istat and in 2016, 42,4% involved treatment and rehabilitation, 38,9% medicines and medical appliances and 10,2% long-term healthcare.
According to data recently published by the MEF (in the publication The monitoring of health expenditure Report No. 6 - 2019, Studies and publications series, Ensure correct planning and rigorous management of public resources), the health expenditure of the citizens transmitted, within the Health Card System (TS), to the Revenue Agency from the providers of healthcare services, for the purposes of the tax return, amounted to 30 billion and 48 million in 2017 and 32 billion and 29 million in 2018. As regards the type of expenses, according to this source, in 2018 it was 9 billion and 51 million products purchased in pharmacies, 7 billion and 49 million for medical visits - of which 4 billion for dental visits -, 85 billion for services in accredited private structures and 6 million for services in authorized health facilities.
Of particular interest is the elaboration produced by the Mef in terms of types of expenditure and disbursement structure again for 2018 (figure 3.4), which shows that 44,7% of expenditure concerned medical visits and interventions, of which: 32% for dental services, 24% for services in authorized structures, 20% for services in private structures, 17% for non-dental medical visits and 7% for services in public structures. In addition to visits and medical interventions, 15% of the expenditure concerned the purchase of drugs, 10,3% the payment of co-payments, 10% the purchase of medical devices, and almost 18% other expenses.
The region in which private spending is highest is the Lombardia (7 billion and 65 million again in 2018), followed at a considerable distance by Lazio (3 billion and 53 million), from Veneto (3 billion and 26 million), fromEmilia Romagna (3 billion and 9 million), and from Piemonte (2 billion and 62 million).
As regards the reasons for resorting to the private sector, from the studies recently carried out by CREA-Sanità (Observatory on waiting times and costs of health services in Regional Health Systems, II year - 2018, Rome 1.02.2019) we know that recourse to the private sector certainly has to do with the times of access to services and the relative costs. Waiting times in public and private structures with which we have an agreement are in fact considerably longer, in some cases even 10 times higher, than those in private structures and also compared to those of services provided in the public sector under the Intramoenia regime. While the differentials in terms of expenditure between the ticket and the cost of the service in the private sector or in Intramoenia are much less accentuated (this is in most cases a ratio of 1 to 2 or 1 to 3).
Furthermore, most of this private spending takes the form of an expense not intermediated by third parties, Which insurance companies and health funds, and as such subject to a particularly high risk in terms of lack of appropriateness and self-managed healthcare consumerism (as reported for example by the Gimbe Foundation in the 3rd Sustainability Report of the National Health Service of June 2018). And we know that the amount of healthcare expenses deducted in the tax return in 2018 amounted to 18 billion and 500 million euros, of which 3 billion and 300 million per co-payment. While the deductions for supplementary healthcare still amounted to 2018 billion and 6 million in 355. Above all, from the point of view of the strategic management of a universal healthcare service, private spending on healthcare out of pocket generates iniquity, as it favors citizens and families with greater economic resources.
In light of this situation, it can be said that as envisaged in the DEF for 2020 in terms of the abolition of the superticket from 1 September 2020, an increase of 2 billion in the National Health Fund and the allocation of two funds of 500 million each for innovative oncological and non-oncological drugs, it certainly goes in the desirable direction of promote equity and the universality of services, reducing the costs charged to users and trying to improve and expand the offer, but constitutes still too weak an intervention compared to the reality of Italian private health expenditure.
