To healthcare -37 billion in ten years and less care for the most fragile: subsidiarity as a recipe

Underfunding with approximately 37 billion cumulative cuts over the decade 2010-2019, made 'without regard to quality and equity'. Lack of proximity and lack of integration between health and social and health care. Finally, shortage of personnel and in particular of general practitioners. These are the 'ills' of the National Health Service - with its 'progressive loss of universalism and equity' - that most affect the lives of the frail and needy. This is what emerges from the Report 'Subsidiarity and ...health' produced by the Foundation for Subsidiarity and presented to the Chamber of Deputies, which proposes a 'new social pact for a comprehensive reform'.

The survey carries out a check-up of the SSN, starting with the renunciation of care, which rises from 9-10% of the general population to 20% among the most disadvantaged. Another case in point is integrated home care: it covers about a third of the non-self-sufficient while a large part of the care remains the responsibility of families. On whose shoulders expenditure will rise from 18.6% in 1980 to 25.7% in 2023 (+7.1%) while the share of public health production in the total will fall by 2.7 points between 1980 (63.9%) and 2022 (61.1%). Third example, mortality 'pegged' to educational qualification: the rates of avoidable deaths per 10,000 residents equal to 39.6% for those with an elementary school diploma drop to 20.3% in the case of a university degree.

"Subsidiarity is the institutional architecture of universalism, capable of making the right to health effective, measurable and sustainable over time," explains Giorgio Vittadini, president of the Fondazione Sussidiarietà. We need a social pact that puts the defence of the individual person back at the centre, under the motto "there is no democracy without care" of which Europe and Italia should be proud, while elsewhere many sick people are dying in the streets".

Stressing the need for full socio-healthcare integration in a country context in which, in 2023, social spending - net of pensions - amounted to just under 110 billion while health spending was 138 billion, is the director of the Institute for Finance and Local Economy (Ifel) Pierciro Galeone: "In the current context, the contiguity between the two spheres is increasingly marked and integration increasingly necessary," he points out. He then goes on to recall how the current lack of integrated information sources makes it possible only to estimate sociomedical expenditure, starting from the main public financers/givers, i.e. local health authorities (35%), municipalities (5%) and INPS (60%): "The public contribution to the sociomedical world is estimated at between EUR 45 and 47 billion," he explains, "in the context of a complex system in which flows of resources and responsibilities are intertwined between different institutional and operational levels.

The request promoted by the experts is fully accepted by the Minister of Health Orazio Schillaci: 'The principles of subsidiarity, especially the horizontal one, are the method by which to ensure the founding values of a universalist system like ours, which is a point of reference, especially abroad, where the SSN is seen by all as a health service of great quality and a model,' he points out. 'And in the face of the growth and increased complexity of health needs, it is important to enhance the contribution of society and the Third Sector.