Deficits and wrong treatments, all the evils of health

by Luca Cifoni
ROME (July 17) – Italy does not spend more on healthcare than other Western countries. Indeed, in reality total spending (about 9 percent of GDP, between public and private) is lower than the OECD average. However, our healthcare system, which is judged overall to be good from a qualitative point of view even at an international level, is unwillingly in the position of posing continuous problems for the public finances, of leaving large sections of citizens dissatisfied, and finally of creating a dangerous terrain of contact between politics and the underworld (if not organized crime).

The causes of this situation are obviously various, but a good key to understanding is given by the very strong differences that exist between one Region and another. Differences in spending, performance, balance of accounts. In the end, even if cross-referencing quantitative evaluations with qualitative ones is always a complicated undertaking, one gets the impression that at least in some cases the regional realities that produce the greatest deficits are also those that treat less appropriately.

Efforts to restore health care accounts have been going on for several years now, and some results are starting to show. In 2007, the national health service spent around 102.5 billion euros, an increase of 2.9 percent over the previous year. The growth is contained, if we consider that in the first years of the decade the average increases were 7 per cent. The overall deficit of 3.2 billion, down sharply compared to 2006, was the lowest in recent years.

But what is inside this huge mass of money? Meanwhile, expenditure on personnel represents 32.5 per cent of total costs, around 33 billion. Approximately 80 percent of this sum goes to pay doctors and nurses, the rest goes to administrative staff. Pharmaceutical expenditure is worth a little more than 15 per cent of the total, and has recently been significantly reduced. For the rest, without going into details, a couple of considerations can be made. The first concerns the role of hospitals: in Italy there are too many, often small and inefficient. Their number will have to be reduced. The second observation, connected to the previous one, arises from demographic trends: in the future there will be more and more elderly people, and it will be inevitable to strengthen territorial assistance and in particular home care (which today absorbs relatively few resources) to the detriment of hospital care.
Health services are provided by the Regions, which for this reason receive, among other things, Irap revenue. They do so by following laws and guidelines drawn up at national level, but then moving with great autonomy in management. And the differences are visible. Let us first look at per capita spending. The national average is 1,731 euros, but – excluding Valle d'Aosta and the Province of Bolzano which are somewhat special cases – it ranges from 1,965 in Lombardy to 1,581 in Calabria. A higher expenditure does not necessarily indicate problems in the accounts, given that some Regions can afford it. The disc