Analysis

Gimbe: Expenditure-to-GDP ratio frozen until 2029 and 30 bn gap in benefits

President Cartabellotta: 'Without new investments the regions will be forced to increase the tax burden or cut services'

by Ernesto Diffidenti

28 April 2026

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3' min read

Translated by AI

Versione italiana

Key points

Financial statement 2025
forecast 2026
Estimates 2027-2029
Gap between healthcare expenditure forecasts and the National Health Fund

3' min read

Translated by AI

Versione italiana

Health expenditure will remain at a standstill at 6.4 per cent of GDP until 2029, and in the three-year period 2027-2029, compared to forecasts, there will be a shortfall of 30.6 billion needed to guarantee services to citizens. This is the central figure of the Gimbe Foundation's analysis of the Public Finance Document 2026, approved on 22 April by the Council of Ministers.

The picture shows a growing gap between the estimated needs and the resources already planned for the national health fund. "And in the absence of substantial, but unrealistic investments starting from the next Budget Law," comments Nino Cartabellotta, president of the Gimbe Foundation, "this imbalance can only be unloaded on the budgets of the Regions, which will be forced to increase tax pressure or cut services.

The Gimbe Foundation has examined the 2025 final health expenditure, the forecasts for 2026 and the estimates for the three-year period 2027-2029, comparing them with the expenditure forecasts and the public funding allocated, taking a snapshot of a public health service that is increasingly under financial pressure.

Financial statement 2025

For the year 2025, the 2026 PFD certifies a health expenditure/GDP ratio of 6.3%, unchanged from 2024, confirming that in relation to the wealth produced by the country, health expenditure remains stable. In absolute terms, in 2025 health expenditure amounts to 141,539 million, an increase of 2.5% compared to 138,335 million in 2024. "The increase of €3,204 million between 2024 and 2025," Cartabellotta observes, "is significantly lower than last October's forecasts: in fact, the Public Finance Planning Document, updating the forecasts of the DFP 2025, estimated healthcare spending of €144,021 million, almost €2.5 billion more than the 2025 final figure. This is a clear sign of how unstable healthcare expenditure forecasts are and, above all, they are always downwards'.

forecast 2026

For the year 2026, the PFD estimates a health expenditure/GDP ratio at 6.4%, slightly up from 6.3% in 2025. In absolute terms, the projected healthcare expenditure is 148,522 million, an increase of 6,983 million (+4.9%) over the previous year. "Considering that the last Manoeuvre set the national health fund at 143.1 billion for 2026," Cartabellotta explained, "the forecast for health spending is unrealistic without increasing regional deficits. That is, as with the 2025 final balance, it is likely that this forecast will subsequently be revised downwards'.

Estimates 2027-2029

The ratio of healthcare expenditure to GDP remains frozen at 6.4 %. In absolute terms, the health expenditure forecast rises to € 151,222 million in 2027 (+1.8% compared to 2026), to 155,059 million in 2028 (+2.5% compared to 2028) and to 159,443 million in 2029 (+2.8% compared to 2028). "Behind the apparent stability in the share of GDP earmarked for healthcare spending," comments President Gimbe, "lies a fragile picture that is easily exposed to downward revisions, due both to economic stagnation and geopolitical uncertainties. Above all, there is no sign of any reversal in the country's policies, which envisage allocating a percentage increase to healthcare that is lower than GDP growth'. In fact, for the three-year period 2027-2029, against an average annual nominal GDP growth of 2.6 per cent, the 2026 PFD estimates an average annual increase in healthcare expenditure of 2.37 per cent.

Gap between health expenditure forecasts and national health fund

If on the one hand the estimates of the 2026 PFD outline the stability of the health expenditure/GDP ratio, on the other hand, according to Gimbe, they conceal a serious pitfall for the Regions. In fact, the growing gap between the expenditure forecasts of the 2026 PFD and the resources allocated by the latest Manoeuvre translates into an increasingly evident financial tension for the regional budgets. The gap between FSN and healthcare spending, equal to about 3 billion in 2023, has increased to 4.3 billion in 2024, a year in which the Court of Auditors has already certified a deficit of more than 1.5 billion for the regions. And the gap is destined to widen further: € 7.1 billion in 2027, € 10.1 billion in 2028, and € 13.4 billion in 2029, configuring, as of today, an increasingly marked structural defunding of the NHS. On the whole, in fact, in the three-year period 2027-2029 the gap between forecasts of healthcare spending to provide the essential levels of care and available resources amounts to € 30.6 billion. "In the absence of substantial but unrealistic investments starting from the next Budget Law," comments President Gimbe, "this gap is not just a technical fact, but a time bomb for the Regions' budgets, which without additional resources will only have two tools to avoid the Deficit Recovery Plans: cutting services and increasing taxes. And it will still be the citizens who will pay".