The criteria envisaged by the new system for allocating national healthcare needs generated in 2023 a redistributive impact between the Regions amounting to 219 million euros. This is what emerges from the Focus published byParliamentary Budget Office (Upb), which analyzes the implications of the new resource distribution mechanism and the effects of the reform.
The new system for allocating national healthcare needs favors the South
The new system for allocating national healthcare needs was defined with the Agreement in the State-Regions Conference of 21 December 2022 and the decree of the Minister of Health of 30 December 2022 and introduced from 2023. The new criteria "recognizing that the state of health and healthcare needs are not determined exclusively by age but also by socio-economic conditions, rebalances the distribution of financing to ensure greater adherence between the health needs of the territories and the resources allocated to their satisfaction".
From a practical point of view, the new mechanism complements the capitation criterion, which takes into account the influence of age on healthcare consumption, also “the tmortality rate under 75 years of age and some indicators of socio-economic conditions, such as relative poverty, low education and unemployment”.
According to the Parliamentary Budget Office, the application of the new parameters produces in particular an "increase in resources for the Regions in which conditions of socio-economic marginalization are more widespread", therefore mainly in Noon.
Numbers in hand, in fact, in 2023, the new mechanism attributed 84 million more to Campania, 56 million more per Sicilia, 45 million more per Puglia and 21 more at Calabria. At the same time, the resources allocated to Lombardia (-71 million), Veneto (-33 million) ed Emilia Romagna (-30 million).
The critical issues of the reward share
Together with the indistinct portion of the national healthcare requirement, the distribution includes some portions of financing that follow specific distribution criteria. Among these there is the so-called reward share, which has increased over the years and is equal to 0,5% of the overall financing in 2023. The Upb highlights how the reward share is divided based on agreements free from pre-established criteria and the result of negotiations between the Regions, which generally seem to take into account and compensate for any unfavorable effects arising from the distribution of indistinct financing or from other causes. These negotiations, notes the PBO, "on the one hand contribute to promoting the achievement of overall agreements on the allocation of resources, but at the same time reduce transparency of the overall distribution mechanism".
“Suffice it to say that, while the new criteria were applied to an amount of resources equal to 1,8 billion in 2023, the premium share in the same year was 644 million (equal to a third) and that, being attributed with discretionary criteria, this share can ensure a significant advantage for some Regions", states the PBO giving the example of Lombardy, Liguria and Lazio who obtained 155, 108 and 53 million respectively, more than compensating for the loss suffered due to the new distribution criteria, while Campania and Puglia, with 131 and 16 million respectively, consolidated their gains.
The analysis also highlights how, for the purposes of the distribution based on the premature mortality, it would appear more coherent to take into account the differences in the population structure by age group of the different Regions. This would be an advantage especially for Campania (around 8 million) and Lombardy (3,5 million). On the other hand, the current methodology has mainly benefited Piedmont, Liguria, Sardinia and Tuscany.
Furthermore, the inclusion in the division of the other criteria envisaged by the law (L. 662/1996 and Legislative Decree 68/2011) remains unimplemented, such as the territorial epidemiological indicators or the progression paths of quality standards, waiting for adequate data to be available and for the problems associated with privacy regulations to be resolved.
Finally, the PBO notes that an evaluation of the joint weights of the variables could be useful “age” and “deprivation” on the basis of the healthcare consumption recorded in the final balance to weigh the respective role of these two determinants of healthcare need and, to this end, also in this area and always with full protection of personal and sensitive data, the available information bases should be strengthened.
