Italy is getting older. With a sobering demographic curve and new economic challenges to keep under control. It is on these points, and above all on the correlation between people’s well-being and productivitywhich some experts present in Rome on the occasion of the Meridiano Sanità Forum focused on “Health for all Policies: towards a new strategic vision of the healthcare system for the growth of the country”. Among the approaches hypothesized to improve the situation and support growth in the long term, attention was focused on the activities of prevention and on the rapid adoption of innovations in the scientific and technological fields.
How demographics have changed and how much it weighs on the National NHS
Over the last 50 years, the process of aging of the population has transformed the demographic structure of Italy by shifting the demographic pyramid towards the older age groups, with significant effects not only on healthcare spending but also on the available workforce. Forecasts indicate for 2040 a gap of 3.4 million workers.
The proposal that emerges from the Forum is to urgently address the issue of sustainability of NHS financing over time in an integrated manner, working jointly on multiple dimensions. What to do? The directions talk about policies to encourage birth ratespolicies to promote participation in the labor market (primarily skill mismatch, women and young people) and increase the attractiveness of our country for attract human capital from abroad. With particular attention, in this sense, to encouraging the return of “brains especially in key sectors such as the life sciences”.
New challenges are added to the demographic transition, including not only economic difficulties – there are 2.2 million families and 5.7 million individuals in absolute poverty – but also theincrease in territorial differences, job uncertainty, growing mental distress, climate change and the increase in territorial differences – in Italy there is a 3 year gap between the Region with the highest and lowest life expectancy at birth.
How are the Italians?
The Italians they live longer and longer but the years lived in poor health have increased from almost 11 years in 2004 to almost 16 in 2023, due to a high prevalence of high-impact pathologies caused by a multiplicity of risk factors starting from sedentary lifestyleobesity, smoking. Non-communicable diseases, together with infectious ones, are responsible for over 19.5 million DALYs (substantially the life expectancy adjusted for disability, therefore an index of global severity of a pathology) of which 40% concern the population in working age, with a greater impact on women, which translates into a productivity loss of 97 billion eurosequal to 4.6% of Italian GDP.
What can be done
A clear vision of the future emerges from the Forum. An intervention strategy on risk factors, vaccinations and screening, in addition to significantly improving the health of citizens, would contribute to the sustainability of the NHS, with avoided costs equal to approximately 544 billion euros in 10 years.
The value emerges from the sum of direct and indirect costs avoided thanks to the improvement of risk factors (smoking, alcohol, sedentary lifestyle, poor diet), the reduction in the incidence of diseases preventable through vaccination (anti-HPV in adolescents and anti-pneumococcal , anti-Herpes Zoster and anti-flu in over 65s and in cancer patients) and early diagnosis through oncology screening programs (breast, cervix and colorectal).
The value of prevention
According to Valerio De Molli, Managing Partner and CEO of The European House – Ambrosetti and TEHA Group, a global vision is needed.
“It’s clear that invest in the health of the population it is a necessity, not only to guarantee the well-being of citizens and the community, but also to improve productivity and accelerate the economic growth of the country”, explained the expert.
It is therefore necessary to focus on health prevention, focusing on healthy lifestylesimmunization and screening campaigns.
“These are fundamental tools for improving health conditions and containing future costs for the healthcare and welfare system, and contributing to the reduction of territorial differences – is the opinion of De Molli. Alongside improving good health and strengthening the NHS, objectives at the center of the healthcare agenda, to increase productivity it is also necessary act on industrial policyfocusing on strategic sectors such as pharmaceutical”.
To return to growth, the country needs to focus on strategic sectors characterized by a high intensity of R&D, high multipliers of economic activity, a larger company size and highly qualified employment.
The importance of the pharmaceutical sector
With an added value per employee and investments in production per employee double that of manufacturing and investments in R&D per employee equal to 8 times that of manufacturing, the pharmaceutical represents a driving force for growth, innovation and productivity that is part of a highly dynamic health ecosystem. However, we need to work to increase the attractiveness of the country by simplifying the legislation and introducing reward mechanisms also as compensation for the effects of payback for companies that invest in Italy in the production and research system.
The commitment to research and development reflects the vocation for innovation that characterizes the pharmaceutical sector at a global level: in 2024 there are over 22,800 drugs in development (+7.2% compared to 2023). With reference to 2023Italy is in 2nd place after Germany in terms of number of medicines made accessible to patients on the national territory out of the total number of medicines approved at European level (129 out of 167 medicines in total) and, among the main European countries, at 3rd for average access time (424 days between approval of the drug at European level and reimbursement at national level), after Germany and England, progressively improving.
Reimbursability at a national level is followed by the regional access phase, assessed by Meridiano Sanità according to 3 dimensions:
- the time of access to medicines (time from the publication in the Official Journal of the reclassification decision / Price & Reimbursement regime to the 1st purchase at regional level by at least one healthcare facility)
- the availability of the drugs themselves (number of drugs for which at least one consumption was detected at regional level out of the total drugs)
- the actual use of drugs purchased by NHS structures.
From a starting sample represented by the 61 drugs containing new active substances that received a positive opinion from the EMA during 2021 for the 1st therapeutic indication, 38 were selected among those reimbursable and for which a sale was recorded in at least a Region or PA For these drugs, whether orphan or non-orphan or assessed as innovative by AIFA, there are notable regional differences in terms of access for patients.
The median access time (equal to 3.7 months for non-innovative orphan drugs, 4.1 months for innovative drugs and 5.6 months for non-innovative non-orphan drugs) presents a time gap of more than 6 months between the fastest and slowest Region in making the drug available.
As regards availability, no Region has purchased, and therefore made available, all the drugs covered by the analysis (availability is equal to 63% for non-innovative non-orphan drugs, 57% for non-innovative orphans and 52% % for the innovative).
Regarding the actual use of drugs, the Region that uses drugs the most has consumption more than twice as high as the one that consumes the least. They emerge from the data significant regional differences resulting from different regional access systems which generate differences in the timing and equity of patient access to therapies, especially in favor of the more innovative ones.
