Healthcare, from Bolzano to Sicily high costs and inefficient services

If you want to find the best hospitals in Italy, you have to go to Trento, where the ministerial report card on essential assistance levels (Lea) scores almost full marks, 97 points out of 100. In order to obtain it, however, the Autonomous Province spends 1,4342 euro per citizen, that is 24.1% more than Tuscany, which in the monitoring of the Lea has only one point less (1,081 euro per person, 96 points); in the comparison with Veneto (1,061 euro), which trails them at 94 points, the distance grows to 26.5%.
The different demographic size naturally affects the per capita expenditure figure, but this factor certainly cannot be invoked to explain, for example, the numbers shown by Campania, which spends as much as the Veneto, but scores 22 points less (72) in the analysis of the quality of services, or by the Province of Bolzano, queen of expenditure (1,562 euros per citizen) destined for hospitals that offer, however, services that are among the worst in Italy (62 points, the same as Molise, better only than Sardinia and Valle d'Aosta).
In the excellence, which can be circumscribed above 90 points, in addition to Emilia-Romagna we also find Marche, which, however, devote only 972 euro per capita to the hospital area: the same as Sardinia, penultimate in the ranking with 60 points, the minimum for sufficiency.

The Autonomies section of the Court of Auditors continues in the substantial evolution of the analysis of territorial public spending that began a few years ago, and in its new report on the financial management of Regions and Autonomous Provinces (Resolution 15/2025; see also yesterday's Il Sole 24 Ore) proposes a key interpretation that may prove crucial in the debate on the fate of healthcare: in a discussion that has so far focused on funding levels, in the game of figures that rise in absolute terms and turn out to be much less lively in their relationship with GDP, but has been almost disinterested in the quality of spending.
Graphs and tables drawn up by the accounting magistrates shed light on precisely this aspect. Which is clearly central, because it is obvious that if we do not look at the actual levels of services, we risk financing inefficiency. Indeed, as the report shows per tabulas, the same expenditure can result in quite different services.

To construct this analysis correlating costs and benefits, the Court relies on the most solid official data available. Expenditure is taken directly from regional budgets, while the service results are those just photographed by the latest monitoring of the Essential Levels of Care published by the Ministry of Health on 5 May.
The examination of the LEAs X-rays health care across the board, summarising the results in three report cards dedicated to the district area (from waiting lists to the elderly treated in RSAs) and hospitals. In each of the three areas, the score goes from zero to 100, and asks to reach 60 to indicate at least sufficiency: that is, the intensity of service considered indispensable to guarantee the right to healthcare, protected by Article 32 of the Constitution. To guarantee this, money is not enough, the Court of Auditors points out, showing how often financial commitment and results are unrelated.

Hospitals have already been mentioned. The discourse changes little when we look at territorial medicine.
There the Veneto once again excels, scoring 96 points with a cost per citizen of 1,312 euros: slightly more than the 1,288 euros per head borne by Sicily, with results, however, summed up by a very modest score of 44, less than half that of the Veneto. Lombardy, which in recent months has battled a great deal in controversy with the official monitoring criteria, scores 76 points, i.e. 20 less than Veneto, spending only one euro less per capita per year (1,311 euro), while the most worrying picture comes from Valle d'Aosta, which with 1,353 euro of expenditure per citizen fails to go beyond a very modest score of 35.

Increasingly important, even if less voluminous in financial terms, is the area of prevention, which measures the results of territorial healthcare in activities such as vaccination coverage of children, screening of adults, and controls against the contamination of foodstuffs, drugs, and phytopharmaceuticals.
Here too it is Veneto that stands out, having gained 18 points in three years in the official monitoring of the Essential Levels of Care, which brought it to 98 points, the same points awarded to the Province of Trento. It managed to do so with an expenditure of 104 euros per year per citizen, higher than that of Trento (97 euros) but lower than that of Campania, which, with 119 euros per capita, barely reaches sufficiency, of Bolzano, which, with 117 euros, does not reach sufficiency (98 points), and of Sicily, which sinks to 49 points. Calabria spends slightly less than Trento (95 euros compared to 97), but with only 41 points it is confirmed as the Region with the worst service levels.