RGS Report

Healthcare spending set to reach 159 billion but remains at 6.4 per cent of GDP, with pressure set to come from care for the non-self-sufficient

Sustainability will depend not only on the quantity of resources but also on the ability to adapt the organisation and its staff to meet the care needs of the most vulnerable

by Paolo Del Bufalo

23 September 2026

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4' min read

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Versione italiana

Key points

The painting
The ‘personal’ factor
The National Recovery and Resilience Plan (PNRR) and future sustainability
Older People and Long-Term Care
Lack of self-sufficiency is the driving force

4' min read

Translated by AI

Versione italiana

More billions for the health service, but without an increase in its share of the economy in the short term, whilst in the long term, an ageing population and a rise in those requiring care are set to profoundly shift the demand for care.

This is the picture that emerges from the State General Accounting Office’s report, ‘Medium- to long-term trends in the pension and social care systems – 2026 update’, which has just been published and which sets out the trend in healthcare and social care expenditure up to 2070.

The painting

In 2025, public healthcare expenditure stood at 141.5 billion, equivalent to 6.3 per cent of GDP, representing a 2.5 per cent increase on the previous year – lower than the 4.1 per cent rise indicated in earlier forecasts. In 2026, however, a much sharper rise is forecast: 148.5 billion, up 4.9 per cent, with the share of GDP rising to 6.4 per cent. However, between now and 2029, that percentage will remain unchanged: expenditure will reach 151.2 billion in 2027, 155.1 billion in 2028 and 159.4 billion in 2029, consistently remaining at 6.4 per cent of GDP.

This is a key factor to bear in mind when comparing resources for the National Health Service: a nominal increase in funding does not necessarily equate to a rise in the share of healthcare expenditure relative to the wealth generated. In fact, over the three-year period 2027–2029, healthcare expenditure will rise by an average of 2.4 per cent per year, compared with nominal GDP growth of 2.6 per cent.

The ‘personal’ factor

A significant proportion of the growth in 2026 is also accounted for by staff costs. Income from employment rises to 47.985 billion, up 7.3 per cent, mainly due to the 2025–2027 contract renewals, allowances and other pay rises. Intermediate consumption reaches 49.239 billion (+3.4%), whilst services purchased from private producers rise to 46.747 billion (+4.2%). Of this total, 8.389 billion relates to state-subsidised pharmaceuticals and 7.710 billion to general medical care.

The National Recovery and Resilience Plan and future sustainability

The second stage concerns the post-PNRR period. For 2026, the forecasts include over 3.5 billion in expenditure under Mission 6: Health. From 2027, however, the challenge will be to maintain the infrastructure that has been put in place. The Report estimates annual costs of just over 1.3 billion to be covered by the NHS’s ordinary funding to sustain, once fully operational, the initiatives launched under the NRRP and linked to the territorial reorganisation provided for by Ministerial Decree 77. The crux of the matter, therefore, is not merely to build community centres, operational hubs and new services, but to ensure a sustainable supply of staff and resources to keep them running.

Older People and Long-Term Care

The pressure becomes even more apparent when looking beyond 2030. In the baseline scenario, healthcare expenditure rises from 6.3 per cent of GDP in 2025 to 6.5 per cent in 2030, to 7 per cent in 2040, to 7.3 per cent in 2050, and reaches 7.5 per cent around 2060, before stabilising at 7.4 per cent in 2070. This trend is driven primarily by demographic factors: the number of older people is rising, and with it the need for care, whilst the working-age population is declining in relative terms, with implications for economic growth as well.

The area where the change is most pronounced is that of long-term care, which relates primarily to disability and lack of self-sufficiency. In 2025, it will account for a total of 1.67 per cent of GDP, and almost three-quarters of expenditure – 74.7 per cent – will be allocated to the over-65s. Healthcare accounts for 39 per cent, carer’s allowances for 42.7 per cent and other welfare benefits for 18.3 per cent.

By the end of 2025, care allowances alone accounted for around 2.185 million benefit payments. And the healthcare component of long-term care (LTC), which currently stands at around 0.65 per cent of GDP, is set to rise to nearly 0.9 per cent by 2070. Between 2029 and 2070, according to the National Audit Office’s projections, the increase in healthcare expenditure as a proportion of GDP will be more than three times that of expenditure on care for acute conditions.

The profile of those requiring care is also changing. The proportion of long-term care (LTC) expenditure allocated to those aged over 80 – which stood at around 51 per cent in 2010 – will rise to 57 per cent in 2040 and reach nearly 69 per cent in 2070. Furthermore, around half of spending on care for those who are not self-sufficient currently consists of cash benefits: home care accounts for 19.8 per cent of the total, whilst residential and semi-residential care accounts for 29.9 per cent.

Lack of self-sufficiency is driving

The key issue going forward, therefore, will not simply be how much the National Health Service (NHS) spends, but where and on what needs it will have to spend that money. In the short term, the main pressures come from contracts, staffing and operating costs; in the medium term, the services launched under the National Recovery and Resilience Plan (PNRR) must be made permanent; in the long term, the rise in the number of people requiring care will shift an ever-increasing proportion of demand towards local services, home care and long-term care.

According to the RGS, the sustainability of the healthcare system will therefore depend not only on the amount of resources available, but also on the ability to adapt its organisation and staffing to a much older population.