Monitoring of health spending, the Regions’ report cards and recovery plans

The Ministry of Economy has published the report cards of the Regions in terms of healthcare spending. Some received excellent marks, while others were postponed. In the second case, the analysis is based on the ability to achieve the objectives of the so-called recovery plans. The report illustrates how capable the Regions are of managing the health service in the best possible way, while respecting the economic balance that this requires. In practice, positive results translate into Regions with functioning healthcare, while the Regions with recovery plans are those with other criticalitywhose economic problems often also affect the operations of the structures.

Which are the Regions with the best results and which are confirmed among the “worst”, i.e. subjected to obligations set out in the recovery plans or to forms of commissionership?

Report card on economic spending: the best regions

The report on healthcare costs of the Regions of the Ministry of Economy is divided into Regions with positive results, therefore not subject to a recovery plan, and Regions with critical results and the need for a recovery plan. The results are purely economic, but as anticipated, these are the reflection of a more or less functioning regional healthcare system, two data that tend to overlap.

In any case, looking at the economic results, the report confirms that the “best” Regions are:

Specifically, the region Piedmont in the fourth quarter of 2023 it was in deficit of 227.7 million euros. Thanks to some recoveries, it managed to ensure economic balance, but the report states that we are awaiting the closure of the company losses and further information transmitted by the region, in order to align these results with the financial statements and checks carried out .

Similar situation also for the region Liguriawhich in the fourth quarter of 2023 was in deficit of 74.773 million of euros. Within the legal deadline, i.e. April 30, the Liguria region covered its expenses, managing to avoid a budget in the red with a surplus of 0.006 million euros. The experience is similar once again for the region Tuscany. In the first meetings it resulted in deficit of 251.4 million eurosbut, having covered some expenses, managed to ensure economic equilibrium as expected, thus avoiding the formal notice procedure.

Even the situation in Basilicata it does not differ from the previous examples, except in a more critical way. In fact, it took the region a long time to find the resources to cover the expenses, even going beyond the expected times. For this reason, the report continues to urge the Region to monitor the management of the healthcare system, which “currently proves insufficient” precisely because of the difficulty in fulfilling reporting obligations in a timely manner.

Recovery plans: the Regions postponed

After the Regions that did well, those that hesitated but finally made it, it is time for the Regions that were postponed and have been postponed for a long time. These Regions, in particular, are those with the greatest difficulty in managing healthcare costs and this is also evident in the management of services, which are often reflected in the Central and Northern Regions.

For these regions in difficulty, a recovery plani.e. a model whose aim is to identify the weak points, the measures to be adopted, the timing with which to adopt them and the economic effects of these. All with the aim of achieving economic balance like the Regions that fared better.

But how is it done? The main interventions are: the containment of personnel costs, for example by blocking turnover; an increase in efficiency in the model for the acquisition of goods and services; the redetermination of hospital beds; the reorganization of the hospital network; the prediction of spending ceilings and budgets for accredited private providers and, more generally, the criticality monitoring systems are strengthened. In case of failure to implement the recovery plan, the Region risks being warned and placed under special administration.

For example, some of the Regions with recovery plans have managed to complete it and be among the Regions with economic balance, such as Liguria and Piedmont, while other Regions, such as Molise and Calabria, continue with the recovery plan and are currently commissioners. The Abruzzo Region was also placed under commissionership until 2016, the Campania Region until 2020 and the Lazio Region until 2020. Abruzzo, Campania and Lazio have returned to the exercise of non-emergency functions, but have yet to recover from the deficits in health and therefore they remain subject to recovery plans. Only the Campania Region presented a request for exit from the repayment plan, but based on the results of the monitoring, a request was made for a specific program to be able to define the exit from the repayment plan and the procedure is still ongoing.

For 2023, the Regions that are still subject to recovery, support and quarterly and annual monitoring plans due to the highly critical nature of healthcare expenditure management are:

• Abruzzo
• Calabria
• Campania
• Lazio
• Molise
• Puglia
• Sicily