The National Health System (SSN) is in a critical condition due to the definancing that the sector has experienced in the last decade. Now the real risk is that, without huge new funding, the NHS will be close to collapse and forced to cut important public services to citizens. This is what the Regions denounced in a document drawn up by the Health Commission, led by Raffaele Donini, in view of a meeting with the Minister of Economy, Giancarlo Giorgetti, and that of Health, Orazio Schillaci, which took place on 7 March. “Not being able to have sufficient resources to provide all the necessary assistance entails, for our health, the concrete risk of not assisting the weakest sections of the population, with the compression of an essential constitutionally protected right”, is the alarm that the Regions raised during the meeting. Furthermore, in the law document that «If indeed the level of funding of the NHS for the next few years will have to settle at 6% of GDP, a prospect that the regions are asking to be absolutely avoided, then it will be necessary to use a language of truth with the citizens, so that their expectations of the NHS are recalibrated downwards. Painful choices will be necessary, but they can no longer be postponed, in order to prevent the lack of choices from producing even more serious inequities in the system than those already present”. A situation that risks compromising the universal and uniform character that has long distinguished the NHS, but which has been suffering major repercussions in favor of private healthcare for some time now.
The one denounced by the Regions, therefore, is certainly not new, but rather the last desperate call for help to try to solve a problem that comes from afar and which is now reaching its peak with the impossibility of providing citizens with basic care services. For this reason, the Regions have asked the ministers “for the immediate opening of a working table that can share, by and no later than the end of April 2023, urgent and decisive interventions of a financial and legislative nature through which to allow the regions not to stop health planning and avoid the reduction of health and social welfare services”. A proposal in reality only partially shared by Giorgetti and Schillaci who, as far as we learn, have made it known that – at least in the short term – there is not much room for new financial resources. The Regions have also asked “to make enforceable the principle according to which no region must submit to plans for the return or reduction of services or an increase in general taxation due to the lack of recognition of the current financial criticality due to the costs relating to the pandemic emergency and energetic. Otherwise, the Italian universal healthcare system would be progressively and irreparably compromised”.
The document also explains the main reasons that have compromised the economic-financial sustainability of the regional health budgets: among these in first place is theinsufficient level of funding of the National Health Service, on which, unlike what happens for other public administrations, also the financing of the charges for the contractual renewals of the employees and contracted personnel of the NHS. Added to this is the failure to finance a significant portion of the expenses incurred for the implementation of measures to combat the Covid-19 pandemic and for the implementation of the mass vaccination campaign, for over 3.8 billion in 2021, which the Regions had to make up for with their own resources in order to guarantee budget balance. Finally, to weigh is the considerable rising energy costs supported by health and social welfare structures, equal to more than 1.4 billion compared to 2021. During the meeting with the government representatives, the main problems of the sector were pointed out, among which the first place is that of the lack of personnel and the emergency room criticality.
The text points out that “the various public finance maneuvers approved starting from 2015 have had a significant impact on the level of funding that it was possible to concretely guarantee the NHS, to the point that for 2019 there were no more of 10 billion euro, compared to the 125.34 planned», thus reaching a percentage incidence on GDP equal to 7%. This is lower than 9.9% in Germany, 9.3% in France and 8% in the United Kingdom, according to OECD data. This entails at least two important consequences that risk definitively dismantling the public health system: the considerable growth in private health expenditure which in 2021 exceeded 40 billion euros, breaking the symbolic threshold of 25% of total annual health expenditure; and “the worrying prospect that the level of funding of the NHS for 2025 could land at no less than 6.0% of GDP”.
No solutions to the dramatic crisis facing the NHS are foreseen, at least at the moment, and on the other hand it could not be otherwise. Faced with a welfare state system that needs substantial refinancing to become efficient again, there would be only two possible ways: the first consists of violate European budget constraints and rebuild health care by financing it with a deficit (however, an impossible solution without breaking with Brussels), the second instead consists in financing the care for all by increasing the taxation on financial income and large estates (possible solution, in Europe carried out by Spain, but to which the Italian centre-right is ideologically opposed, indeed carrying forward a reform project such as the flat-tax which moves in the opposite direction, further reducing taxes for the better off) . The third option that remains is the one that Italy is actually pursuing: assisting without intervening in the collapse of public health.
[di Giorgia Audiello]