Me, an Italian doctor in Germany: this is how the German healthcare system in crisis bets 130 billion, in Italy only 'aids'

I am closely following the debate on the Italian public health system, and I would like to share some personal reflections starting from an important study that has just been published in Germany, where I currently practice as an orthopaedic surgeon. I refer to the Krankenhausstudie 2025, a study conducted by the consulting firm Roland Berger, which involved more than 850 German hospital managers to take a snapshot of the state of health of the national health system. The results are alarming: three out of four facilities closed 2024 with a loss, and the situation appears particularly serious in the public sector, where 89% of state hospitals are in a negative financial condition.

What makes this research particularly interesting, also from a comparative perspective with Italy, is not only the diagnosis of the crisis, but the strategic reaction that Germany is implementing. In fact, a 130 billion euro investment plan has been announced over the next five years, aimed at renewing hospital infrastructures, improving management efficiency, enhancing digitalisation, and encouraging the transition towards a more ambulatory and territorial healthcare, in line with the new demographic and clinical needs. In parallel, the German system encourages mergers, regional collaborations and synergies between facilities, introducing selective criteria for access to funding. Only hospitals with a clear strategic vision and good economic positioning will be able to benefit from public funds or private credit. This is an approach that rewards planning and aims at a systemic transformation, not mere emergency containment. Of course, not everything is solved: only 50 per cent of the needs are now covered by available resources, and 81 per cent of the executives interviewed consider the EUR 50 billion Transformationsfonds envisaged by the federal government to be insufficient. But the direction is clear: invest now to ensure the future sustainability of the system.

What about Italy? Unfortunately, as an Italian doctor working abroad, I cannot but note with bitterness the lack of a long-term strategy in our National Health Service. After years of cuts and underfunding (more than 37 billion euro subtracted between 2010 and 2019), we continue to rely on extraordinary interventions, without addressing the root of structural criticalities. The Budget Law 2025 envisaged an increase in funding to the SSN of about 1.3 billion, with a progression to 5 billion per year in 2030. But these are, once again, marginal corrections with respect to a picture of increasingly evident deterioration: interminable waiting lists, shortages of healthcare personnel, doctors abandoning the public sector for the private sector or abroad, and citizens forced to give up treatment. The NRP represented an opportunity, but its implementation is still too uneven and conditioned by organisational difficulties and a lack of central vision. What is missing, above all, is a coherent and organic plan for transforming the NHS, which takes into account the real needs of the territory, the demographic transition and the new healthcare challenges.

As a doctor who has chosen to move abroad to work in a system that values skills, recognises the hard work involved, and offers contractual stability, I cannot help but notice that Italy continues to lose valuable professionals, without putting in place serious policies for their return or for the enhancement of young doctors who decide to stay. The paradox is that many of the countries that now attract Italian doctors - Germany, but also the Gulf States - do so precisely by investing in the quality of public healthcare, offering stable contracts, competitive salaries, and decent working conditions. The comparison with Germany, although there are many differences between the two systems, shows us that even in times of crisis it is possible to act with lucidity and farsightedness. We need the courage to make choices, even unpopular ones, but necessary to ensure the survival of the system.

Our SSN does not need one-off 'little helps', but a courageous and shared reforming vision: an extraordinary structural investment plan, a review of organisational models, overcoming regional inequalities, and renewed attention to the dignity and safety of healthcare personnel. If we do not act now, the risk is that, in a few years, there will no longer be a public system to save, but only to rebuild.