how much the state spends on hospitals

Very different levels of are available in Italian metropolitan cities health care. A situation reflected very well by a specific figure, avoidable mortality, which calculates the number of cases in which a person has died even though the National Health System should have made the necessary resources available to avoid it.

In the meantime, healthcare spending is slowing down, after the investments made in the first years following the pandemic COVID-19. Furthermore, the risk of new cuts is approaching, given the budget situation which could force the State to further reduce the funds allocated to the National Health System.

The ranking of metropolitan cities by health care

Istat has released data regarding the healthcare situation in Italian cities for 2021. In our country there are over 230 thousand beds in hospitals, which in turn number more than 1,000 in total. Rome it is the city with the most beds per inhabitant, while a Cagliari there is the greatest concentration of those dedicated to acute cases, in Turin that for rehabilitation and others Bologna for long-term care. Beyond the excellence, however, the picture varies greatly depending on the individual city, especially if we look at one of the main indicators for the level of healthcare, avoidable mortality.

TO Turin this figure is higher in the city center than in the municipalities of the so-called first belt, the band just outside the territory of the city proper. However, if we go further, towards the hinterland, the situation worsens rapidly even compared to the central data. However, the figure remains higher than the national average, standing at around 20 avoidable deaths per 10 thousand inhabitants compared to the 19.2 national average. With 6.4 beds per 1,000 inhabitants, the municipality of Turin remains above the national average of 3.6, while both the municipalities of the first and second belt are slightly deficient.

Milan is in a similar situation. The municipality has a higher avoidable mortality than the first belt, but similar to that of the second. Here, however, the average drops to 17, well below the national one. Similar data also regarding the concentration of beds, which is very high in the municipality as well 7 per 1,000 inhabitants, but significantly lower than the national average in the municipalities of the two belts. Scenario that also repeats itself Bologna, Venice and Genvoa where, however, the municipalities furthest from the center do not have any beds available.

Florence is by far the city with the lowest avoidable mortality, under 16 in total and under 15 in the capital. However, the concentration of beds in the outer belts is still low, exactly as happens in Rome, where, however, avoidable mortality is higher than the national average. A trend that is confirmed as we continue southwards, throughout the Peninsula. Bari, Naples, Palermo, Messina, Catania and Reggio Calabria they all have avoidable mortality higher than the national average in almost every single municipality in the metropolitan city. The worst situation is that of the capital of Campania, with over 27 deaths per 10,000 inhabitants.

Cagliari instead it manages to remain within an average more similar to that of the northern and central regions. With 18 avoidable deaths per 10,000 inhabitants, the Sardinian capital remains below the national average, also thanks to a high concentration of beds available in the city, as well as 11 per 1,000 inhabitants, the highest ever. However, the hinterland municipalities pay for this concentration at very low levels, around 1 bed place per 1,000 inhabitants.

Health spending in Italy after 2020

Much of this data is related to the health spending, the amount of funds that the State invests in the treatment and prevention of diseases that affect citizens. In recent years the trend of this data has been very particular, also due to the Covid-19 pandemic and the lockdowns which have changed some parameters. The symbolic year for this effect was obviously 2020, when spending reached 7.3% of GDP, with over 122 billion euros according to data from the Economic and Financial Documents. However, the figure relating to the gross domestic product is partly distorted by the collapse in the production of wealth in the country in that year, equal to 9.5%.

The following year, 2021, was a transitional one. Health spending increased significantly, by over 5 billion euros, exceeding 127 billion total, with a rate of change of 4%. However, it was still a partially pandemic context, with a very high number of hospitalizations due to the circulation of new variants of the Coronavirus and a vaccination cycle still not completed by a large part of the population. 2022 was still an expansive year. The State was able to take advantage of the relaxation of European rules to invest further in healthcare, even if the increase in GDP brought the relative weight of healthcare spending to 6.7%. However, they surpassed themselves 131 billion eurosnew nominal record.

In 2023, however, this growth not only stopped, but reversed course. There was a decline, according to the Def, of approximately 0.4%. 500 million euros. The decrease was also confirmed in relation to GDP, despite the growth slowing down in turn. Now healthcare spending stands at around 6.3%. For the next few years, the government plans an expansion to 138 billion in 2024until you get to 147 billion in 2027, maintaining just over 6% of GDP as the target. Hopes which, however, could be frustrated by the budget situation, which could also require spending reduction measures in various areas to recover from the excess debt created during the pandemic.