Almost ten year increase in life expectancy in just over forty years. A record among high-income countries. Measuring the value of the National Health Service, this is the most striking data. From 1978, when it was founded, to 2019, life expectancy has gone up from 73.8 to 83.6 years.
And now? Now we are in troublefor many reasons ranging from increasingly reduced funding for healthcare to the changing demographics of the country and technological evolution, which offers increasingly effective and targeted but also more expensive solutions. In this panorama, there is still one piece of data that offers a positive interpretation. Even in the face of increasingly less sustained financing and the objective difficulties linked to access to services by the less well-off groups, with the risk of inequalities.
Italy spends less on healthcare but continues to have i best health indicators in the world including life expectancy, low infant mortality e high adhesion to screening and vaccination campaigns. This is stated in research published in the magazine Sistema Salute, entitled “Healthcare spending in European countries – The Healthcare Expenditure in the European Countries”.
The elements that give hope
The investigation examines the data of public and private health spending of 10 European countries. The analysis shows that Italy and Spain have annual per capita expenses of 2,212 and 2,034 euros respectively, compared to most European countries which spend more than double (Sweden, Denmark and Germany were above 5,000 euros in 2022) .
However, when health indicators are analyzed, theItaly, together with Spain and Sweden (all three with systems of a predominantly public nature), results ai first places among the 10 European countries considered in the research.
How can we explain this apparent discrepancy with perceived reality? The study, conducted by Carlo Signorelli, professor of general and applied hygiene and director of the School of Specialization in Hygiene and Preventive Medicine, of the Vita-Salute San Raffaele University, with Antonio Pinto, Luigi Epifani and Massimo Minerva, tries to give an explanation . And it tries to make people understand how Italy and Spain spend less, but still have better health performance indicators.
In our country, in addition to limited spending on healthcare personnel (42% less for doctors and 25% less for nurses, compared to European averages), certainly influence the containment of healthcare spending by a good integrated prevention systemthe Mediterranean diet, the lower cost of goods and services and perhaps also the waste reduction policy that has been in place for some years.
The worrying trend
The Scientific Committee of the European University Hospital Alliance (EUHA), which brings together some of the main European university hospitals and of which Carlo Signorelli is a member, has expressed its position on European healthcare systems.
Through the document, just issued, entitled “Rethinking Healthcare Systems”, which is the result of a series of meetings between members of the Committee, convened between March and May 2024, EUHA calls for a global, multinational and context-sensitive transformation of healthcare that considers innovation, integration and prevention is a fundamental cornerstone for guaranteeing the best state of health for the population of the various European countries and guaranteeing sustainability and resilience of health systems.
In the document, EUHA responds to the urgent need for healthcare reforms across Europe, highlighting the central role of university hospitals in guiding these reforms and proposing an action plan, describing the key features to create sustainable health systems that focus more on the best use of new technologies, healthy lifestyles and adequate training of healthcare personnel. The objective always remains the sustainability of European healthcare systems.
“Spending should increasingly take into account some priorities such as technological innovation, prevention and equal access to treatment – comments Signorelli. Italy, despite the objective difficulties, holds a virtuous position which must be maintained with appropriate and incisive government interventions”.
The ever-increasing weight of private contributions
The data tell us that probably, by calculating the percentages allocated to healthcare in relation to GDP, we have for some time been faced with a underfunding of the National Health Service. And the trend is destined to continue for 2025. All this, in the face of conditions that raise alarm, starting from the “backtracking” of some health indicators to reach the difficulty accessing diagnosis and treatment and, above all, to a progressive increase in inequalities.
This must give rise to reflection, also in light of the assessments recently proposed by the CNEL in the context of the Report on public services.
In front of one public health spending which is still in the lowest parts of the ranking of European countries, is in fact growing citizens’ private spending. In 2022 it has reached over 40 billion. And the Court of Auditors predicts a growth in “out of pocket” costs, i.e. borne directly by families, will reach around 47 billion in 2028. More or less 2% of GDP.
These are data that make us think and explain how we tend to give up diagnosis and treatment paths more and more frequently. According to the numbers, in 2023, around four and a half million people have given up on visits and testswithout considering checks at the dentist.
