Healthcare, shocking numbers: from the 40,000 missing doctors to those who give up treatment

Manoeuvre on the grill in the hearings at the Chamber of Deputies, with eyes focused in particular on healthcare with numbers that worry about the health service's resilience: "In 10 years 30% more doctors will be needed," warns the Bank of Italy. And if the Court of Auditors emphasises that the level of healthcare spending will return in 2026-27 to the levels of 2019, i.e. exactly the same as before the Covid emergency, the Parliamentary Budget Office points out how funds for healthcare grow "less than spending, with risks for the Regions' to all end up in deficit. Finally, ISTAT recalls how in 2023 7.6 per cent of Italians - about 4.5 million citizens - gave up healthcare mainly because of waiting lists or for economic reasons.

Among the most heated debates around the manoeuvre are precisely those on resources for healthcare in the coming years, divided between the 'records' boasted by the government and accusations of underfunding by the opposition. The numbers, as always, speak a clearer language. And those lined up by the Court of Auditors confirm that the manoeuvre "in 2026-27 stabilises spending at 6.4% of GDP" (as calculated in Il Sole 24 Ore of 25 October), that is, at "a level equal to that recorded before the crisis (it was 6.41% in 2019)". Such a dynamic, the accounting judiciary acknowledges, "reinforces the weight of healthcare in relation to overall primary current expenditure", in a "prospective picture of the sector" that remains, however, "increasingly less decipherable". For the Parliamentary Budget Office, however, the increase in direct funding to the health service is lower than that of expenditure, with a gap that triples between 2024 and 2027 and produces "a significant risk of an increase in the deficit of regional health services, which could continue even after 2027".

The Bankitalia hearing points the finger at the other open wound of the SSN in addition to that of counted funds: the shortage of doctors and nurses. Once the maxi plan for 30,000 recruitments envisaged by Health Minister Orazio Schillaci has been put back in the drawers, precisely because of the resources with the dropper in the manoeuvre, the numbers of missing healthcare personnel remain heavy, especially in view of the take-off in 2026 of thousands of community homes and hospitals envisaged by the National Reform Programme. According to Bank of Italy, over the next decade the turnover of healthcare personnel and the new needs of territorial care will generate a need, in terms of incidence on the workforce at the end of 2022, for doctors (including family doctors and paediatricians) equal to 30 per cent and for nurses to 14 per cent: on balance, this means more than 40,000 doctors and the same number of nurses. With even more pronounced dynamics in southern Italy. Under current legislation, explains Via Nazionale, all personnel aged 60 or over at the end of 2022 will cease working over the next ten years: this corresponds to more than 27,000 doctors, more than 24,000 nurses and the same number of technical staff, and 28,000 doctors and paediatricians. Mission 6 of the NRP on the expansion of territorial care will also require at least 19,600 nurses and 6,300 socio-healthcare workers, mostly in addition to the current allocation.

In 2023, 7.6 per cent of the Italian population - around 4.5 million - had given up treatment, compared to 6.3 per cent in 2019, with the share of those who gave up due to long waiting lists standing at 4.5 per cent (2.8 per cent in 2019), followed by those who gave up for economic reasons and inconvenience of the service. The such worrying data on the renunciation of care was recalled by the president of Istat Francesco Maria Chelli, who during his hearing also returned to the issue of staff shortages. "The endowment and ageing of medical personnel represent critical issues for the healthcare sector, also in light of the future increase in demand for care due to population dynamics. In particular, it is general practitioners and nurses who are the categories that are 'most concerned about future prospects'. The number of nurses and midwives in Italy in particular "has for many years been considered insufficient compared to the health needs of the population" with an allocation in 2022 of 6.8 per thousand inhabitants, 0.4 points more than in 2019. Among the regions," Chelli explained, "there is a wide gap, with a particularly low endowment of 5.7 nurses and midwives per thousand residents in Lombardy, Campania and Calabria, and 6.0 in Sicily.