After having achieved economic-financial equilibrium while managing to maintain good results in terms of population health, the National Health Service (NHS) must now resolve some territorial imbalances and take up the challenge imposed by the fragmentation of society, which it creates new weaknesses and new needs. This was stated in the Oasi 2018 Report - Observatory on companies and the Italian healthcare system, presented today at Bocconi by Cergas, the research center on healthcare and social assistance management.
In 2017, the NHS, according to the Oasi Report edited by Francesco Longo and Alberto Ricci, recorded a slight accounting deficit (282 million euros, equal to 0,2% of current public health expenditure), with the regions of the Centre-South which are now proving to be as virtuous as those of the North. Lazio, for example, recorded a surplus of 529 million and Campania 77. In the same year, NHS spending increased by 1,3% to 117,5 billion euros, bringing the average increase from 2012 to 2017, at a nominal 0,6% per annum, equivalent to a zero increase if inflation is taken into account.
Italian health expenditure is equal to 8,9% of GDP, against 9,8% in Great Britain, 11,1% in Germany and 17,1% in the United States, with the NHS covering 74%. In the last 5 years, the share of health expenditure on total welfare expenditure has decreased from 22,8% to 21,8%.
The main indicator of population health, life expectancy remains excellent (82,8 years in 2016), but it is growing less than elsewhere, so much so that, from 2010 to 2016, Italy went from second to sixth place in the world in the World Health Organization longevity ranking. While death rates from all major diseases are declining, Mortality due to mental disorders is on the rise and diseases of the nervous system. Territorial differences still remain rather marked: life expectancy in good health is 56,6 years in the South and 60,5 years in the North, with Calabria settling at 52 years and the autonomous province of Bolzano arriving to 69. Until 2016, before the introduction of legislative limitations, also the territorial mobility of patients on the South-North axis was increasing.
What remains unfulfilled is, however, above all the demand arising from social change, which leads to a progressive fragmentation: in 2017, 32% of households were single-person (8,1 million individuals, of which 4,4 million over 60) and the ratio between the over 65s and the active population, at 35%, it is the highest in Europe. Between 2010 and 2017, the over 65 population increased by 1,3 million people (+11%). This is an increase due to the aging of the numerous demographic cohorts of baby boomers: a physiological and positive trend in itself, because it confirms the long life expectancy over 60 years. It is to worry imbalance between the over 65 population and the working age population, which decreases due to the drastic drop in births. Indeed, over the next 20 years, the ratio between the over 65s and the active population will go from 35% to 53%: over one "elderly" for every two people of working age.
This evolution creates and will create increasingly serious imbalances in the social-health services which, according to the Observatory, today they manage to cover only 32% of the need. Particularly critical is the availability of beds in healthcare facilities for non self-sufficient elderly people, amounting to around 2015 in 302 compared to 2,8 million people who would need them. The system also struggles to ensure continuity of care for the elderly following hospitalization: one out of four over 85s is hospitalized at least once a year, with an average hospitalization of 11 days, but only 16% of these are discharged in some form of continuity of care.
From an organizational point of view, the authors of the Observatory note, the conditions of NHS personnel are becoming increasingly critical. The block on turnover, which has been used for years as the main tool for reducing costs, is making its effects felt: 53% of doctors are over 55 and the number of candidates for medical specialties is more than double that of contracts funded. "The problem is the scarcity of resources to hire and train residents, not the lack of doctors," says Alberto Ricci. In administrative role profiles, the share of over 55s is 44% and between 2006 and 2016 the number of under 35s decreased by 64%. In Italy, the nursing staff is less than half that of Germany (5,6 nurses per thousand inhabitants, against 12,9) and the southern regions still suffer the most: in 2016, Lombardy recorded 9,6 NHS employees per thousand inhabitants , Campania 7,3 and Lazio 7,1.
Despite the many criticalities, the Italian healthcare sector and its companies confirm themselves as a dynamic sector open to innovation, not only in the clinical field, but also on the managerial side. The Oasi 2018 Report dedicates several chapters to these dynamics of "karstic innovation", such as the enhancement of professional knowledge, the redesign of programming and control systems, the strengthening of operations management (patient logistics and production assets) and many others wait. Of course, there are still open questions. "In the context of financial and institutional stability, companies confirm their ability to activate new management tools and service models, but it is necessary to identify the strategic priorities towards which to direct innovation", concludes Francesco Longo. «Furthermore, the instantaneous times of political-media communication and the long implementation times on the administrative side are increasingly different. The role of management remains that of identifying strategic priorities and overseeing their implementation, aware of the elements that determine one's own spaces for autonomy».
