When it comes to essential services, it’s not just about report cards – we need to understand who spends the money most effectively
A study shows that all regions (except one) have improved their Essential Levels of Care (LEA) over the last five years, but at very different costs
At the end of June, the Ministry of Health carried out its annual assessment of the regions’ ability to provide Essential Levels of Care (LEA) to citizens. The NSG indicators are invaluable for those involved in planning at national and regional level; every regional director, councillor and president is presented with evidence that clearly indicates where the priorities lie. In the media, for the benefit of the public and local and national politicians, it also provides an opportunity to draw up a ranking of the best and worst performers. These ‘report cards’, whilst taking all necessary precautions, offer a true snapshot of the National Health Service’s performance. A very recent analysis published by researchers at the Altems Health Policy & Management at Altems shows that the NSG score calculated for each region over the last five years is strongly correlated with the main indicators of population health calculated by Istat: in essence, the NSG is the appropriate tool for measuring the regions’ capacity to ‘deliver’ the Essential Levels of Care (LEA), whilst simultaneously measuring the healthcare system’s capacity to contribute to people’s health. For this reason, I believe that these figures must be taken very seriously.
The publication of the 2024 data provides an opportunity for a longitudinal analysis (2020–2024) of what has happened to the National Health Service (NHS) as we emerge from the pandemic. The message for decision-makers is clear: the NHS has improved its ability to guarantee Essential Levels of Care (LEA), but progress is not yet uniform across regions or between prevention, community care and hospital care; the process of convergence has begun, but is far from complete.
In reality, to understand whether – despite being a long one – the path we are following is the right one, it is essential to correlate these ‘scores’ with the resources that the regions have allocated to achieve those results. The Altems analysis mentioned above combines data from the Ministry of Health’s National Health Survey (NSG) with economic and financial data (on funding, expenditure and the regions’ management performance) from the Ministry of Economy and Finance (MEF) and the Regional Government Service (RGS). The aim is to analyse ‘performance’ (health vs. costs), seeking to understand whether the value generated for Italians by the increased resources made available by governments in recent years has translated into ‘health’ in the same way across all regions, and whether there are regions that are proving to be better at utilising them than others.
The study shows that all regions (except one) have improved their Essential Levels of Care (LEA) over the last five years, but at very different costs. And the analysis reveals something unexpected: for example, it highlights that the region with the greatest increase in LEA scores, relative to the same level of expenditure growth, was Calabria, followed by Liguria and Lombardy. Calabria increased its expenditure by €314 per person between 2020 and 2024, resulting in a 20-point rise in its Lea score (+46%), at a cost of €16 per Lea point; Liguria, with an additional €305 over five years, improved its score by 17 points (+25 per cent), at a cost of €21 per LEA point gained; the Lombardy region, with an additional €258, improved its score by 12.5 LEA points (+16%). In this special ‘ranking’ of the top eight regions, four have been on a recovery plan for many years, but only in the last five years (some, though not all) do they seem to have found the right gear. It is interesting to note that the top performers in the NSG reports circulated in recent days – Veneto, Tuscany and Emilia-Romagna – are instead lagging behind in this ‘special’ ranking. And this was to be expected, as it is more difficult to improve when one is already highly efficient and effective. But on closer inspection of the data, we notice two things: all three are close to the top but have not quite reached it yet, and they have performed very differently during this ‘climb’. Over the last five years, Veneto has seen its LEA score rise by 11.3 per cent, spending 30 euros for every additional LEA point, whilst Tuscany has grown by 7 per cent, spending 36 euros per LEA point gained; Emilia, which has increased its LEA score by 3 per cent (2.7 additional points over five years), spends 107 euros more per capita than in 2020. These figures, whilst not perfect, call for serious reflection on the challenge of ensuring the sustainability of the National Health Service (SSN) within an unstable geopolitical landscape and a public finance context that is, to say the least, complicated. The time has come to thoroughly review the SSN’s governance model, embarking on a path that requires a broader concept of broader concept of ‘convergence’, because the objective from now on is not only to reduce regional disparities in the provision of Essential Levels of Care (LEA) but to do so using management models aligned with best practice – which must be sought even where one might not expect to find them.
*Professor of Business Organisation, Faculty of Economics, Università Cattolica del Sacro Cuore
