Private health spending: between myth and reality. Presented the AIOP Report on the hybrid financing of the health system
The AIOP event ‘Private health expenditure: between myth and reality’ was held in Rome on Tuesday 17 June, during which the new Report by the AIOP Study Centre was presented, entitled ‘Spending on health goods and services: the hybrid financing of the health system’. The event turned the spotlight on the issue of the alleged “privatisation” of Italian healthcare and tried to dispel some of the myths that inhabit the public debate with an evidence-based approach and a thorough verification of sources.
Pr Gabriele Pelissero, what are the main issues that led AIOP to publish its report?
The healthcare debate today is often too ideological and not data-driven. Therefore, by the end of the year, AIOP will present a report with technical proposals and operational solutions. There is a distorted narrative on ‘privatisation’. Contracted operators also perform a public service and are fully integrated into the NHS. As regards healthcare expenditure, from 2010 to 2019 it decreased (-0.10% of GDP per year), then rose again only in 2024 (from 6.19% to 6.31% of GDP). However, it should be noted that tariffs have not been updated, while costs are increasing, with repercussions that obviously impact labour relations.
Private healthcare expenditure in Italy is stable at around €43 billions – compared to €138 billions of public expenditure in 2024 – and is not growing at the expense of the public sector. It follows an autonomous dynamic, responding to different needs and not replacing the National Health Service. More than 50 per cent concerns non-LEA (Essential Levels of Care) services – such as dentistry, drugs and prescriptions – not guaranteed by the Italian NHS. The rest includes services also covered by the public, but freely chosen by citizens, such as gynaecology and obstetrics. In the last two years, despite the pressure on the public system, there has been no increase in private expenditure, nor a compensatory effect. In the last year of the survey, private healthcare expenditure assumed one of the lowest values of ever, falling below 2% of GDP.
There is no privatisation of healthcare, also because household spending does not play a compensatory role in relation to the trend of NHS expenditure. Today, two systems coexist: public healthcare – with public and accredited private operators – and a parallel system, which has always existed and accounts for 25 per cent of total expenditure. We cannot ignore this reality. If we want to protect citizens’ health effectively, we must start from the data and work to improve the integration between public and private. Private spending is now a structural and indispensable component of our healthcare system.
What was the response of the Ministry of Health?
The response from the Ministry of Health was very positive. Indeed, Stefano Moriconi, Head of the Health Minister’s Technical Secretariat, conveyed greetings and appreciation for the initiative from Minister Orazio Schillaci. Moriconi emphasized the crucial importance of acknowledging the role of accredited private healthcare, asserting that it is an integral part of the National Health Service (NHS). He clarified that it is misleading to view it merely as a form of private profit, as it significantly contributes to the provision of services, particularly those falling outside the essential levels of care (LEA), which the NHS cannot fully guarantee on its own. Moriconi further highlighted that for at least the past 15 years (with a brief exception in the last two), there has been a reversal in health investments. He underscored that if society does not enjoy health and well-being, other investments become pointless, as a less healthy society is inherently a poorer one. Finally, Moriconi identified demography as the true determinant affecting both health and the organization of private healthcare, stressing the need for increased investment in prevention and a synergistic public-private strategy across the entire system.
Similarly, the Undersecretary for Health, Marcello Gemmato, in his letter of greetings, underscored the necessity of fostering a virtuous collaborative system between the public and private sectors. Gemmato highlighted the accredited private sector’s vital role as a valuable ally in resolving specific critical issues and overcoming the persistent territorial inequalities.
View the press article on the AIOP website
