La public spending on healthcare in Italy has known profound transformations over the last hundred years. Between 1960 and 2024, the ratio between healthcare expenditure and GDP has experienced different phases, alternating periods of growth, temporary contractions and stabilizations, influenced by economic factors, technological innovations, political decisions and demographic changes. After the peak reached during the Covid-19 pandemic, the Health spending has returned to 2019 levels, reaching 6,3% of GDP in 2024 (equal to 137,9 billion euros).
The latest forecasts of the State General Accounting Office (RGS) indicate that health spending will start to grow again in the coming decades, mainly due to the aging of the population. By 2060, the share of spending allocated to those over XNUMX will double, while that for younger age groups will decrease. However, these forecasts do not take into account crucial factors such as technological evolution and the effects of climate change on public health.
This is what emerges from a deepening ofItalian Public Accounts Observatory signed by Charles Cignarella.
The historical trend: between growth and contractions
Between 1960 and the late 80s, the sPublic health burden in Italy has almost doubled in relation to GDP, reaching 6%. The phenomenon was common to all advanced countries and was mainly due to:
- The introduction of new medical technologies, which have improved the quality of care but increased its costs.
- Un loose financing system, with the regions being able to exceed spending limits by counting on the intervention of the central government.
In the 90s, theItaly's entry into the Economic and Monetary Union ha I put a brake on growth of health spending. Compliance with the Maastricht parameters forced the government to remove the so-called soft budget constraint, that is, the guarantee of coverage of budget overruns by the regions. The crackdown has led to a reduction in health care spending compared to GDP between 1992 and 1997.
Since 1999, with the adoption of the euro and the decline in interest expenditure on public debt, the health spending has started to grow again until 2010, when it reached a new peak, also due to the global financial crisis. Subsequently, between 2011 and 2019, the expenditure-to-GDP ratio decreased, reflecting public spending containment measures. The 2020 pandemic represented atemporary exception, with a significant increase in resources allocated to healthcare, followed by a return to pre-pandemic levels in 2024.
Projections for the future: growth driven by ageing
Rgs forecasts indicate that, starting from 2030, the health spending will start growing again until 2055-2060, stabilizing thereafter. This growth will be mainly determined by demographic factors:
- The population aged 8 and over will increase from 2024% in 14 to 2070% in XNUMX.
- Spending on people over 1,3 will rise from 2,5% to XNUMX% of GDP, reaching a third of total spending.
- The share of spending for the younger population (0-64 years) will decrease, while it will remain stable for the 65-79 age group.
90% of the expenditure will be allocated to the care of the so-called acute pathologies (which include all health services, even non-serious ones). However, spending on health services will grow more rapidly. long-term care (LTC), that is, long-term health care for people who are unable to look after themselves, aimed primarily at the elderly.
The critical issues of forecasting: technology and climate change
The RGS projections are based exclusively on demographic evolution, but they do not take into account other elements that could significantly influence health spending:
- Technological innovation: New therapies and advanced diagnostic tools could increase health care costs more than expected, as has happened in recent decades in advanced countries. According to the OECD, health care spending could grow much faster than estimated by the RGS.
- Climate change: Extreme weather events, heat waves and new environmentally related diseases could increase the demand for care, impacting on healthcare costs. Older people are particularly vulnerable to the direct (deaths and injuries) and indirect (heat stress and air quality related diseases) effects of global warming.
- Health investment policies: the need to make the health system more resilient to future shocks may require further investments in staffing, digitalization and organizational innovation.
What challenges for the future?
To ensure an efficient and equitable health system in the coming decades, it will be essential to adopt appropriate strategies to meet new challenges. Some key aspects include:
- Strengthening the health system with targeted investments, both in infrastructure and human resources.
- Improving the efficiency of the healthcare sector, for example through digitalisation and the introduction of innovative care models.
- Planning sustainable financing policies, to prevent the growth in health spending from putting pressure on the public budget.
Demographic trends indicate that demand for care will continue to grow at least until 2060, making it essential to adjust health spending. However, future political choices and technological evolution will play a fundamental role in defining the level of spending needed and its sustainability in the long term.
