To public health 6.3% of GDP (decreasing) and Italians spend more than other Europeans on treatment

The funding of the National Health Service has been slowing down over the last decade (with the exception of the Covd years), now standing at 6.3% of GDP, i.e. below the level of most other countries in Europe, and with Italians being among the Europeans who, in percentage terms, put more money into their wallets to pay for care privately, while the health funds (paid for by workers' contributions) have grown, with the number of members practically tripling over the same period. These are some of the main trends in healthcare in Italia as photographed by the Parliamentary Budget Office (UPb) in a Focus on the role of the market in the Italian healthcare system. A report analysing the dynamics of financing, production, and integration between the public and private sectors, and highlighting the weak points of an NHS that is finding it increasingly difficult - as the numbers show - to respond to citizens' needs.

According to the UBP, the trend in the financing of the health service continues to fluctuate: after rising from 6.6 per cent to 6.3 per cent of GDP between 2012 and 2019, it peaked at 7.3 per cent in 2020 and then returned to 6.3 per cent in 2024. Direct household expenditure - the report goes on to emphasise - has remained essentially stable at around 2 per cent of GDP, while the component financed by voluntary schemes - insurance and health funds - has increased by 0.1 percentage points to 0.3 per cent of GDP over the last period. In the face of the lack of growth in public funding, the share of public expenditure in relation to total health expenditure has, however, fallen: in 2023 it stood at 73.1 per cent of total expenditure, compared to an EU average of almost 81 per cent. This percentage is higher in Germany (85.9 per cent) and France (84.4 per cent), while it is lower in Spain and Italia (both just over 73 per cent), as well as in Portugal and Greece (just over 60 per cent) . Outside the EU, the United Kingdom has a public coverage of 81.2 per cent.

In Italia, direct household expenditure on public investment stood at 23.6% of the total, about 9 points above the European average. In particular, the UBP reports that direct household expenditure (the so-called 'out-of-pocket') stands at less than 15% of the total in the EU and the United Kingdom, but reaches significantly higher levels in southern European countries: 34.3% in Greece, 29.3% in Portugal, 23.6% in Italia and 20.9% in Spain. In Germany and France, on the other hand, it is below the European share, with values of 11.1 and 9.3 per cent respectively. "The incidence of private expenditure," underlines the Parliamentary Budget Office, "reflects several factors: the limits of public coverage with respect to a growing demand for services, driven by improved living standards, an ageing population and technological progress, and possible phenomena of demand induction by supply, which may lead to consumption that is not fully appropriate".

Among the trends in recent years is the growth of supplementary healthcare, with the number of members of healthcare funds increasing from 5.8 million in 2013 to 16.3 in 2023. "In the last available year, these funds disbursed resources amounting to over 3 billion, of which almost two-thirds referred to benefits of a substitutive, and not supplementary, nature with respect to those guaranteed by the SSN," emphasises the document, which calls for monitoring the possible effects on the equity of the health service deriving from supplementary instruments: "it should be noted that corporate welfare in the health sphere is structurally more widespread among workers employed in medium and large-sized companies, characterised by stable employment relationships and medium-high income levels, as well as prevalently concentrated in the northern regions, with obvious implications from a distributional point of view," reads the Upb report. In numerical terms, voluntary financing schemes - excluding direct payments - account for 4.6 per cent of health expenditure in the EU as a whole. Most of the countries considered do not deviate significantly from this value, except Portugal, where the share reaches 9%, and Italia and Germany, where it is close to 3%.