OASI Report: the Achilles Heel of the Italian Healthcare System is Care for the Dependents

BEDS COVER LESS THAN 10% OF NEEDS AND HOME VISITS AMOUNT ON AVERAGE TO 17 HOURS PER PATIENT PER YEAR. STAFF EXPENDITURE IS SUFFERING, WITH CONSEQUENT AGING OF HEALTHCARE PROFESSIONALS. A WARNING ABOUT THE NORTHSOUTH GAP IN POPULATION HEALTH

In 2016, the Italian Healthcare System (Sistema Sanitario Nazionale, SSN) spent €115.8 billion, an increase of 1.1% on 2015, while the average increase per year between 2010 and 2016 has been 0.7%  - less than inflation, the OASI Report 2017, presented this morning at Bocconi University, observes.  Health care expenditure, which in 2010 accounted for 24% of public welfare expenditure, fell six years later to 21.9% in favor of assistance expenditure, from 8% to 10%, while pension expenditure remained substantially stable at 68%.
 
Personnel expenditure fell by 6 points between 2010 and 2016, resulting in an alarming rise in the average age of staff: 52% of doctors in the SSN are over 55 years old, compared with 13% in the UK, 43% in Germany and 46% in France. Overall, expenditure on goods and services (33.6% of total expenditure) exceeds that of personnel (29.7%).
 
"Public sources", according to the editors of the Report, Francesco Longo and Alberto Ricci, "still cover 95% of hospital expenditure, but only 60% of expenditure on outpatient services and 65% of long-term care costs in residential facilities". And it is precisely the long term and chronicity that prove to be the Achilles heel of the system. Public or private beds for the dependent cover less than 10% of the needs: 270,000 beds compared to 2.8 million dependents. In addition, home visits are largely insufficient to bridge the gap: on average, it is 17 hours per patient taken care of.
 
“The solutions used by families are solvent-based hospitalization, direct care for relatives or caregivers. This mechanism is supported by a balance of factors destined to disappear", Professor Longo says. If today, in fact, the ratio between the elderly and the active population is 35 to 100, in 2065 it will be 60 to 100. The pension system has also protected the average income of the elderly, which has remained almost unchanged between 2006 and 2014, while that of young people aged between 19 and 34 has decreased by 20 percentage points, but the gradual transition to a less favorable system will also reduce pension incomes.
 
While the SSN has been in economic equilibrium throughout Italy for some years, the Report highlights an alarming and permanent gap between the North and South of the country in terms of population health. Healthy life expectancy is 60 years in the North and 56 years in the South, with a gap of 20 years between the two extremes: 70 years in Bolzano and 50 years in Calabria. Even chronic patients’ self-perception of their state of health raises the same alarm bell: in the North 49.6% of them feel healthy, in the South only 36.6%.

by Fabio Todesco