The forecasts regarding health spending, illustrated in the latest Nadef, highlight a modest dynamic in the future, with a reduction in spending as a percentage of GDP; Furthermore, the estimates already include the additional expenditure connected to the implementation of Mission 6 - Health of the PNRR. This implies that the resources to expand and strengthen the equipment, in particular those of personnel, are not very many but the functioning and effectiveness of healthcare itself depends on them.
After Covid, the healthcare system is in difficulty
During the Covid-19 epidemic, it has become clear how much the health system was in difficulty, the indicator most frequently taken as a reference as a measure of healthcare provision capacity was the number of beds (in particular, in intensive care) available. This indicator summarizes a composite set of factors, such as the number of machines necessary for the therapies, as well as the staff that operates such equipment, but it also depends on health policy choices and the characteristics of the health system and cannot therefore be considered as a comprehensive indicator of healthcare provision.
Healthcare: Italy behind on management solutions, few doctors
The availability of beds (for acute, intensive care) is lower in Italy than that found in most European countries (in per capita terms). From the point of view of technological equipment, comparisons with other OECD countries do not point to Italy's particular backwardness, at least at a quantitative level. If anything, Italy is behind when it comes to the adoption of more advanced management solutions, such as the use of integrated electronic health records, telemedicine, online booking systems and virtual care platforms. The real weakness appears to be in the human resources: in 2020 the supply of nurses in Italy was not particularly high, while that of specialist doctors was in line with European averages. However, in some specializations there is an under-equipment of personnel (general practitioners, emergency and emergency doctors, anesthetists first and foremost). Looking ahead, demographic trends point to a progressive exit of doctors by 2030, attributable to the retirement of cohorts of professionals, the replacement may be hindered by the growing attractiveness of private healthcare and the phenomenon of emigration abroad.
The average national data then hides significant territorial differences, analyzed in the report.
Il PNRR it's an opportunity: 16 billion for healthcare
The National Recovery and Resilience Plan (PNRR) it was written when the Covid-19 pandemic was still underway, therefore, it is not surprising that an entire mission was dedicated to the topic of health, as a reaction to the need to respond to the critical issues that the pandemic had highlighted.
The PNRR presents itself as an important opportunity to strengthen the Italian healthcare system. The PNRR plans to implement the reform of local assistance and Scientific Hospitalization and Care Institutes (IRCCS) and allocates a non-negligible part of the resources, equal to almost €16 billionto the healthcare sector. PNRR investments in healthcare focus on various areas.
PNRR where investments are concentrated
First, it is expected the strengthening of hospital and local infrastructures. Furthermore, the aim is to develop the digitalisation of the healthcare system, introducing innovative tools such as telemedicine, which will allow for better provision of services and greater accessibility for citizens. Another objective of the PNRR investments is to strengthen human resources in the healthcare sector, through the increase in grants for the training of new professionals and the strengthening of the recruitment of qualified personnel. A further area of intervention is constituted by promotion of scientific research and innovation in the sector. The establishment of research centers and the development of innovative projects is envisaged, in order to encourage the discovery of new therapies, improve the early diagnosis of diseases and promote scientific progress in the medical field.
Healthcare and Pnrr: there are implementation problems
If the reform steps have actually been completed, as far as investments are concerned we are in the early stages of the process. Given the implementation problems that are emerging, it will be unclear how much of the investments will actually be made by 2026. Furthermore, there are some critical issues regarding the ability to finance current expenditure linked to the enhanced services and to find the necessary staff. In the revision proposal presented in July 2023 by the Government, it is proposed to review some investments, for example by remodulating the number of structures built.
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