OASI Report: Italy's NHS in Identity Crisis amid an Expanding Healthcare System

ACCORDING TO SDA BOCCONI'S CERGAS SCHOLARS, THERE IS AN URGENT NEED TO REDEFINE THE MISSION OF THE NATIONAL HEALTH SERVICE, WHICH HAS REACHED SUBSTANTIAL FINANCIAL STABILITY (E149 MILLION DEFICIT OUT OF E119 BILLION EXPENDITURES, EQUAL TO 0.1%), BUT IS GROWING LESS THAN PRIVATELY FUNDED SERVICES. WITH A STUDY OF THE CAREER HURDLES WOMEN FACE

With €119.1bn spent in 2018 and a deficit of €149mln, the Italian National Healthcare System (Servizio Sanitario Nazionale, SSN) confirms that it has secured its accounts, but highlights both great difficulties in keeping pace with the expansion of the broader health sector and the need to redefine its mission. According to SDA Bocconi’s CERGAS scholars coordinated by Francesco Longo and Alberto Ricci, who presented the 2019 OASI Report on the Italian health system today, the expansion and diversification of the healthcare industry clashes with the contraction of funding sources, producing a rate of SSN coverage on total healthcare expenditure that is already 74% and likely to decrease further.
 
Public health expenditure per capita is €1,900, or 80% of expenditure in England, 66% of that in France and 55% of that in Germany. With one of the highest life expectancies in the world (83 years), accompanied by one of the lowest birth rates (1.32 children per woman) and a forecast of a 1 to 2 ratio between pensioners and the working age population by 2040, the SSN does not seem to be able to keep pace with the growth of health needs.
 
Between 2000 and 2018, the number of people employed in healthcare increased by 18% to 1.4 million (in the same period, residents increased by 6% and employment in general by 10%), but this growth was mainly due to the private sector. Good news from last year is that, for the first time since 2009, the number of physicians in the SSN has increased again (by 384 units).
 
Also in terms of expenditure, between 2012 and 2018, the private sector outperformed the public sector, with a growth of 16% while SSN growth can barely cover inflation. The main component of private expenditure, with €35.7bn, remains the out of pocket component, but the one with the highest growth (+31% from 2012, up to €4.2bn in 2018) is the intermediated part (for example, by private insurance).
 
In such a context, Prof. Francesco Longo states, «It is crucial to clarify SSN’s mission. The choice is between an exclusive focus on services financed by the public sector; management of the production chain, including regulation of the privately-paid market and governance of integration between the two areas; or a holistic interpretation, oriented towards health protection, with the ambition of influencing the entire industry and people’s lifestyles.»
 
Finally, one of the report's in-depth studies concerns women's career paths, revealing the existence of a glass ceiling in healthcare. Women represent 44% of physicians, but only 16% of the heads of operating units, with important variations on a regional basis (Emilia Romagna in the lead with 24%, Veneto in last place with 10%) and among different areas (69% of hospital pharmacy directors, 10-20% of hospital discipline directors, less than 10% in surgery and zero in orthopedics and cardiac surgery). Even in managerial roles, women make up 26% of the list of those eligible for the role of general manager (DG), but only 17% of the DGs in office. From the analysis of the interviews with a sample of women DGs, some diffidence emerges towards positive discrimination, such as quotas, but also the need to make health agencies more women-friendly as for policies of conciliation and organizational culture.






Download the tables:

Women Directors by Region

Women Directors by Area

DOWNLOAD the Report (in Italian) from the CERGAS website

by Fabio Todesco