According to the latest ISTAT data, we are increasingly becoming a country of elderly people, so much so that a real “silver tsunami” is emerging which implies an unprecedented paradigm shift in the management of public health. With a population where the over 65s already represent 25.1% of the total, which is expected to reach 30% by 2030, and spending on non-self-sufficiency that has exceeded the critical threshold of 30 billion euros per year, the current system tends to no longer be sustainable.
How to maintain services? Try to offer new solutions White Paper on Chronicity and Non Self-sufficiencyedited by Sergio Harari, President of the Peripato Association and Professor of Internal Medicine at the University of Milan, and Stefano Paleari, President of the Anthem Foundation and Professor of Public Management at the University of Bergamo, starting from a precise alarm on the imbalance between growing longevity and the crisis of health services. The document is not limited to analysis, but makes concrete proposals for a necessary change of direction. The editors of the White Paper propose incentives for prevention and to make citizens responsible for correct lifestyles from an early age.
What awaits us
From the most recent data released by ISTAT, the structural reality of an increasingly older country in European comparison clearly emerges, which has the lowest share of young people and the highest share of elderly people with 14.8 million over 65s and an average age of 49 years, 4 more than the EU average.
The imbalance, the result of a long-term process, which profoundly affects the demand for health, welfare and social security services, to which the document offers a radical response based on digital innovation and new organizational models to guarantee the right to health of present and future generations.
Today, according to what experts report, even if life expectancy reaches just under 84 years, people remain healthy on average for up to 58. The result: over twenty-five years of life spent living with illnesses or disabilities, with an enormous impact on the quality of life and on families.
As Silvio Brusaferro, former President of the ISS and now Professor of Hygiene and Preventive Medicine at the University of Udine, recalls, it creates
“a gap that generates impressive socio-economic consequences, fueled by the fact that over 24 million Italians, or over 40% of the population, report being affected by chronic diseases today. At the same time, the system is supported by over 8.5 million family caregivers who provide assistance at the cost of enormous personal and professional sacrifices and by over 800 thousand carers, with a strong component of private spending equal to 45 billion euros per year, which is added to the over 140 billion of public health spending, of which just 1 billion is the share deriving from the health copay”.
The role of technology for the future
Future prospects outline an even more critical scenario.
“By 2043, it is estimated that 6.2 million people over 65 will live alone, making current care models completely insufficient in the face of a non-self-sufficient population expected to grow by 25% by 2030”
underlines Luca Degani, lawyer and President of Uneba Lombardia – Third Sector Association that deals with social assistance.
The White Paper identifies technology and new organizational models as the “keystone” to more efficient and therefore sustainable healthcare. It is not just a matter of digitizing documents, but of adopting actual Digital Therapeutics (DTx), i.e. certified software, formulated as apps, video games, virtual reality or sensorized systems, with therapeutic, rehabilitative or preventive purposes in the cardiology, pneumology, neurological, neuropsychiatric and oncology fields, capable of remote, continuous monitoring of pathologies such as diabetes, hypertension and depression, to improve both clinical outcomes and adherence to and access to treatment, even at home.
“These solutions are already reimbursed in countries such as Germany, with average costs per cycle of around 222 euros, but Italy still lacks a structured regulatory system. The introduction of Artificial Intelligence and the strengthening of the Electronic Health Record (FSE 2.0) will allow us to move from ‘silo’ medicine to global management, reducing redundant tests, waiting lists and improper hospitalizations thanks to immediate availability of information and to remote monitoring”
explains Guido Cavaletti, Professor of Human Anatomy and vice-rector of the University of Milan – Bicocca.
A better socio-health integration is therefore necessary aimed at breaking down the barriers between hospital and territory, creating geographical networks where the patient receives adequate care wherever he is intercepted. This is remembered by Rosanna Tarricone, Associate Dean of the SDA Bocconi School of Management – Government, Health and Non-Profit Division and Associate Professor at the Department of Social and Political Sciences of Bocconi University.
“On the resources front, we suggest reviewing the ticket exemption mechanisms, introducing criteria based on real economic-financial capacity to guarantee equity and sustainability. Finally, it is necessary to rethink public-private collaboration and insurance systems so that they return to their nature of covering the risks linked to non-self-sufficiency and are not simply understood as a tool to ‘jump the queue’ by paying a premium”.
