In Italy, out of 27,211 health facilities of which 995 hospitals, mapped by the Ministry of Health and the Department of the Treasury, there are at least 2 million square meters of unusable and unused structures, 36% concentrated in the North West, equal to 4% of mapped sample, a percentage that rises to 7% for structures built before 1945. This is what emerges from a study carried out by the economic studies firm Nomisma and Rekeep Spa, focused on “structural investments and the economic, social and environmental benefits of a territorial medicine “. A 42% health building heritage made up of public structures and the remainder by accredited private structures, which sees 20% of the Regions (Lombardy, Emilia Romagna, Sicily, Campania, Veneto) owning 50% of the structures. And again: 21,055 real estate units with socio-health purposes, or belonging to the ‘hospital’ type, are concentrated in medium-sized (33%) and large (34%) municipalities, while only 24% in areas of the country with a lower concentration of population. The data – comment the authors of the study – therefore highlight that there is not only a regional gap to be bridged by rebalancing the current situation according to the concentration of the population of the regions, but also the need to strengthen the territorial network in order not to overload the centers of larger size. The data on unused health properties – it is noted – also opens the way to important reasoning on the use of existing land with respect to the use of new ones and the opportunity to meet the needs of services and beds while preserving the territory and promoting environmental sustainability.
The study, starting from the current situation – that is, from the health structures already operating in Italy – and from the health model outlined in the National Recovery and Resilience Plan (Pnrr), therefore focuses on healthcare construction, defining the necessary interventions on Hospitals of communities, community homes and nursing homes (Rsa), in order to strengthen networked territorial health care, in addition to the related economic, social and environmental benefits. What are the needs to implement the expected model of territorial health? The study estimates the standard needs (number of structures that would be needed to strengthen local health care) for each of the three types of structures: as regards community hospitals, currently in Italy there are 163 active ones that provide 3,163 beds, mainly concentrated in Veneto (1,426 beds), Marche (616), Lombardy (467) and Emilia Romagna (359). The NRP plans to build 381. To reach the standard needs of one facility for every 50,000 inhabitants, equal to 1,205 community hospitals, it would however be necessary to provide for the activation of a further 66, for a total of 1,042 structures and 13,220 beds. As for the Community Houses (structures that in some areas coincide with the so-called Health Houses), to date there are 489 active in Italy. The region that has the most is Emilia Romagna (124), followed by Veneto (77), Tuscany (76) and Piedmont (71). No structure of this type is instead present in Lombardy. The Pnrr foresees the activation of 1,288 community houses by 2026, but for adequate assistance it would be necessary to have a total of 3,010 structures. In order to reach the standard requirement, therefore, it would be necessary to activate an additional 1,233 structures.
The supply of RSA, on the other hand, is now equal to 14.6 beds per thousand elderly residents (population aged 65 or over), with a strong disproportion between the North and the South of the country, the study observes. Suffice it to say that the Autonomous Province of Bolzano has 42.6 beds per thousand elderly people, Veneto 28.4, Emilia Romagna 15.7, Lazio 5.9, Campania 1.4, Molise 0.8 and the Aosta Valley has no structure. To reach the target parameter of 10 beds per thousand elderly people – under which 11 regions are positioned, almost entirely belonging to the South of the country – it is necessary to activate 527 structures, for a total number of 36,890 beds, under the hypothesis 70 beds in each structure. What investments are needed? The NRR foresees an allocation of 1 billion euros for the construction of 381 community hospitals and 2 billion euros for 1,288 community homes, in addition to 308 million euros to be allocated to residences for the elderly. The amounts include expenses for technological systems. For the construction of the additional structures, the study indicates that the following are however necessary: 1.3 billion additional euros for the activation of a further 661 community hospitals, for a total investment therefore equal to 2.3 billion euros (and an amount of almost 1.2 million square meters); An additional 1.4 billion euros to activate a further 1,233 community homes for an investment which, added to the amount of 2 billion euros envisaged in the NRP, brings the total value to 3.4 billion euros (on approximately 2 million square meters ); 2.3 billion euros for the construction of the 527 RSA (for an area of 2.2 million square meters), to which are added the 308 million already foreseen in the Pnrr. In total, therefore – concludes the study – to implement the territorial health model outlined by the NRP, 8.2 billion euros (amount including expenses for technological systems) would be needed by intervening on 3,563 structures, corresponding to an area of about 5 , 4 million square meters. Part of this amount, equal to 3.308 billion euros, is already foreseen in the Plan, while a further 4.907 billion euros would be required to complete all the interventions.
How and where to find the resources for the construction of the additional structures? An important contribution – according to the authors of the study – could also come from the involvement of private operators: not only private healthcare that could be interested in investing in the creation of new spaces, but also operators of services in support of healthcare, facility management in first and foremost, through the formula of the public-private partnership (PPP), a solution that envisages entrusting the interventions that are repaid through the subsequent management of the property, or through project financing operations to an external company. Private companies could, therefore, be a fundamental ally of the Public Administration, able to put additional resources into the system in an accelerating investment logic, as well as providing the design skills to generate real efficiencies and reduce consumption, in particular in the hypothesis the redevelopment of abandoned buildings. What are the economic, social, health and environmental benefits? The total investment, equal to 8.2 billion euros, could generate an economic driver at national level of 25.7 billion euros (of which 17.1 billion euros as a direct and indirect impact on production, and 8, 6 billion euros as an impact induced on the economy). For every euro invested in the redevelopment and renovation of the identified structures, 3.5 euro would be generated. To this must be added a further economic benefit when fully operational – that is, once the development phase of the structures has been completed – in the sectors of health services and facilities. It is thus possible to observe a propulsive effect that sees a benefit of 160 million euros for facility services (cleaning, surveillance, canteen, laundry and maintenance).