Bills and utilities for 6 billion, fees and administrative expenses for 4.5 billion, maintenance that costs 1.5 billion in a year. The non-healthcare costs of Local Health Authorities and hospitals are worth 12 billion, 11.9% of the total expenditure of the National Health Service and have increased in two years, between 2004 and 2006, more than the total health expenditure: 19.7% against the '11.8 percent.
The picture of the "no core" expenses of Italian healthcare facilities is taken by an analysis by Sole-24 Ore Sanità on the data from the 2006 budgets of Regions and healthcare companies (the latest available), published by the Ministry of Welfare.
Local health authorities and hospitals spent 257 million on telephone calls, 625 million on canteens, over a billion on cleaning, 780 million on electricity, water and gas, 445 million on laundry and 1.2 billion on "other non-health services" including employment contracts self-employed, porterage, surveillance and personal services contracted out to social cooperatives.
The lion's share goes to depreciation expenses, often linked to investments, which alone absorb almost two billion, but bills and utilities for water, electricity, gas, cleaning, surveillance, maintenance and reimbursements together exceed 5 billion: 43% of all "no core" spending.
And these are the sectors in which the most substantial increases have also been recorded in the two years: utilities have increased by more than 40% and non-health services such as porterage, surveillance, etc. of the 44%. The only other item to record increases of this magnitude is that for data processing (+45% approximately), justified however by the rampant computerization of healthcare facilities.
Among the other more expensive "no core" services, then, the most growing are the canteens (+19.03%), rentals (+26.23%) and cleaning services (+21.48%): all activities "outsourced" to the external.
But it is in the Regions that non-health spending is truly patchy. For the canteen, for example, the 2004-2006 differences of the +152% in Liguria fly above the average, followed by +35% by Emilia-Romagna and +33% by Lazio and Sicily. Among the rentals, the highest peaks are in Sicily (+90%), Sardinia (+121%, with a more marked increase between 2004 and 2005), Basilicata (+124%, with a more marked increase between 2005 and 2006) and Campania (+125%, with a more marked increase between 2004 and 2005). And in cleanliness, Liguria (+42%), Lazio (+37%) and Sicily (+66%) are above average.
The increase in the cost of oil already had its effects in 2006. Fuels, fuels and lubricants grew by 23.49%, heating costs by 20.90%: the "coldest" Regions are Sicily (+94%), Marche (+69%), Campania (+64%) and Abruzzo (+48%); the "hottest" are Basilicata (-47%), Calabria (-32%) and Puglia (-18%).
Spending on waste disposal also increased (+22.75%), despite separate waste collection, but ranging from -2% in Bolzano to +47% in Sardinia.
Healthcare claims and disputes also grew, and with them insurance (+14.13%) and legal (+12.07%) expenses. But at the regional level it goes from -79% in Friuli to +73% in Bolzano and Sicily. Issue of management and insurance contracts.
Then the telephone: company data networks and cellular phones raised costs in Sardinia (+47%), Lazio (+24%), Molise (+23%) and Sicily (+20%), while expenses fell in Basilicata (–13%) and Friuli (–5%).
Lastly, at the level of individual healthcare companies, the local health authorities spend more on average than hospitals. Using the average cost per inhabitant residing in the Region as an index, non-healthcare costs for the Local Health Authority of Bolzano are worth 169 euros per capita, while at the Inrca Broncho-Pneumopathies Center in Lecco they are worth only 0.15 euros per citizen.
