Il Italian healthcare system showed resilience, continuing to present favorable health indicators despite healthcare spending lower than the European average. However, it will be difficult to maintain without addressing the current ones shortages e imbalances. The bill (Pdl) represents an important step to improve the national healthcare system, but requires further clarification and adjustments to ensure its effectiveness and sustainability in the long term. These are the conclusions that emerged fromhearing of the Parliamentary Budget Office (Upb) to the Social Affairs Commission of the Chamber of Deputies regarding the bill (Pdl) of 13 July 2023, Chamber Act n. 1298, which concerns the financing, organization and functioning of the NHS and the review of tax breaks for complementary healthcare.
Even before the pandemic, the NHS was experiencing tensions due to consolidation policies accounts public which have caused territorial imbalances, access problems, staff shortages and overcrowding in emergency rooms. The pandemic has aggravated these problems, making structural intervention urgent.
The resource node
During the hearing, PBO councilor Giampaolo Arachi analyzed several crucial aspects of the proposal. First, he examined the financial framework of the PDL. In 2021, the Italian public health spending it was 7% of GDP, lower than the EU average by 8,8%. On a per capita level, Italy spent less than half of Germany and significantly less than France. Despite this, Italy has a high life expectancy at 65 years of age, with significant territorial differences, highlighting strong regional inequalities. The PDL proposes a significant increase in health spending up to 8% of GDP starting from 2024. This increase should be supported by annual financing of the health system equal to double the rate of inflation. However, the financial hedges planned to support this increase, which amount to 4 billion euros from 2025 to 2030, are considered decidedly ambitious. And where would the funds come from? From interventions by spending reviews and, if necessary, byincrease in tax rates and reduction of tax expenses.
“The increase in tax rates – in contrast to the tax policy interventions to reduce the levy implemented in the last decade – instead represents a more immediate way to generate sufficient resources to provide financial coverage for the increase in healthcare financing and spending up to the desired level. However, it would be appropriate for the PDL to provide an indication of which taxes and rates would be affected, also specifying the possible scope of variation", underlined the Parliamentary Budget Office.
Measures to strengthen the NHS
Arachi then discussed the possible distributional effects of the proposed revision of the criteria distribution of financing to the NHS among Italian Regions. The PDL suggests basing the distribution on factors such as age groups and economic deprivation, but the PBO believes that the weight of these factors must be calibrated with greater attention to their real relevance in the state of health. Furthermore, the introduction of other variables, such as environmental, socioeconomic and cultural criteria, would require an in-depth analysis of the interactions between these factors and the possible incentive or disincentive effects.
The PDL also provides specific measures for strengthen healthcare personnel, increase the number of beds hospital e improve il emergency-urgency system. Other initiatives include interventions on the Essential Levels of Assistance (LEA), the revision of homogeneous diagnosis groupings and the strengthening of health research. However, the PBO noted that some of these measures they are not well defined and are not completely coordinated with current legislation, making greater consistency between the expected financial charges, coverage and spending objectives necessary.
Particularly relevant is the proposal to clearly distinguish between replacement services provided by the NHS e supplementary services in the context of supplementary healthcare, limiting tax breaks to the latter. This proposal was welcomed positively by the PBO, which underlined the importance of avoiding improper use of tax breaks. Furthermore, the PBO appreciated the proposals to strengthen transparency and make information from the register of health funds available, suggesting that it would be useful to have access to the administrative data of the Revenue Agency relating to the lower revenue due to these benefits.
