Healthcare: the hunt for funds for recruitment and salaries to stem the exodus from hospitals

A recruitment plan to be prioritised for the new local healthcare system – specifically the more than 1,200 community care homes that are already open and need to be staffed with healthcare professionals to ensure services are provided. And then to try to stem the exodus of doctors – this year, for the first time, voluntary resignations by doctors have outnumbered retirements – and the exodus of nurses from public hospitals: for the former, the aim would be to increase the ‘exclusivity allowance’ – that is, the pay component for doctors that rewards those who ‘swear allegiance’ to the National Health Service by not working in the private sector (currently ranging from 500 to 1,300 euros per month depending on length of service), whilst for the latter – both nurses and other healthcare staff – the idea is to continue increasing the ‘specificity allowance’, which has already risen under last year’s budget. These initial items alone would amount to 1 billion, to which would then be added the other sections of the budget package, ranging from prevention to new essential care standards and tariffs (amounting to a further 2 billion), as well as the remaining individual measures such as those for Alzheimer’s, mental health, autism, addictions and eating disorders. Not to mention the highly contentious issue of medicines, where the aim is to send a strong signal to companies in response to the ‘Most Favoured Nation’ tsunami coming from across the Atlantic, driven by US President Trump to lower medicine prices in America.

As we speak, officials at the Ministry of Health are working on the ‘shortlist’ of measures for the forthcoming Budget Bill, based on the official request that the Minister of Health Orazio Schillaci has already made to his colleague at the Ministry of Economy and Finance (MEF), Giancarlo Giorgetti, namely an additional 5.5 billion for 2027 – a figure that has now risen to between 5.8 and 6 billion. This figure emerged before the deficit cap of 3.1 per cent of GDP had been triggered, but now that the watchword is ‘prudence’ – as Giorgetti himself emphasised in recent days when presenting the Dpfp – those requests are now at serious risk.

The only thing that is more or less certain (as there is certainly nothing certain at the moment) is that the threshold for funding from the Health Fund – the one that keeps the National Health Service afloat, albeit with great difficulty – calculated as a percentage of GDP – is not expected to fall below the ‘red line’ of 6.1–6.2 per cent, a threshold that has not been breached in recent years. Falling below that threshold would be tantamount to leaving oneself open to a barrage of criticism from the opposition, who could launch a lengthy election campaign centred on ‘healthcare cuts’ whilst military spending is being funded. But how much is the commitment to stay above this threshold actually worth? Calculator in hand, it amounts to an extra 3–3.5 billion. Moreover, for 2027, the National Health Service (SSN) inherits just 1 billion from last year’s budget, a small ‘nest egg’ that no one in the Health Ministry would want to see included in the calculation of additional resources for next year. After all, the fact that healthcare expenditure ‘under current legislation’ continues to grow faster than the Health Fund is also confirmed by the Dpfp, which estimates healthcare expenditure for this year at a substantial 148.836 billion, compared with a Health Fund financed to the tune of just over 143 billion, with growth for 2027 reaching 151.668 billion, before rising further to 155.647 billion in 2028, with the ratio of actual healthcare expenditure to GDP standing at 6.3 per cent. This is why the hope in the corridors of the Ministry of Health is that the Ministry of Economy and Finance (MEF) and Palazzo Chigi will take these figures fully into account.

But what might the budget measures entail? If the full amount requested by Schillaci were available, along with a sum of 2–3 billion in unearmarked funding – which the regions would like to see allocated to all areas – the idea is, as mentioned, first and foremost to earmark 1 billion for the recruitment of healthcare staff and pay rises, partly to continue reducing waiting lists. Another billion would be needed to update the essential levels of care and the tariffs for hospital and specialist outpatient services. Finally, another billion would be needed to strengthen prevention measures, such as the new vaccination programme. As regards the pharmaceutical sector, in addition to attempting to raise the contribution calculated from the Health Fund by a further 0.25 per cent, the aim is to slow the growth of the payback burden on pharmaceutical companies grappling with the American enticements of the ‘Most Favoured Nation’ clause on medicine prices pushed for by Trump: to this end, the plan is to utilise the entire remaining unspent sum of around 500 million from the Innovative Medicines Fund, for example by extending the ‘innovative’ status beyond 36 months and introducing fast-track authorisation procedures for new therapies.

The top priority remains healthcare professionals. Now more than ever, we need an extraordinary plan to enhance the status of healthcare professions – doctors and nurses in particular – because without this, we cannot resolve the problems of waiting lists, nor can we address the issue of the sector’s attractiveness to stem the exodus from the public system. If we want to preserve a universal health service, we must start with the healthcare professionals”. So said Filippo Anelli, president of the National Federation of Orders of Surgeons and Dentists (Fnomceo), speaking on the subject of the Budget Bill. Today, Anelli pointed out, “the level of distress in the healthcare system is high. The number of people who are foregoing treatment or who are forced to wait due to waiting lists is very high. We are no longer in a state of alert: we are already in a critical situation. The regions are rightly calling for more resources to cope with the rising costs that, year on year, result in a shortfall compared with the National Health Fund’s allocation. But amongst all the areas in need of resources, the absolute priority remains that of healthcare professionals. The recent Anaao study documents, in a stark and unflinching manner, the exodus from hospitals, with the number of resignations having actually exceeded the number of retirees. This means that the system can no longer cope: people are leaving, workloads are becoming ever heavier, and bureaucracy is stifling. So for many, it is better to work outside the NHS, to work as a private practitioner.”