By Barbara Cittadini, President of the Italian Association of Private Hospitals (Associazione Italiana Ospedalitá Privata – AIOP)
The current health situation in Italy
Italy has faced a massive burden from the coronavirus disease.
Since Feb 21, 2020, when the first case of COVID-19 was recorded in Italy, the National Healthcare Service, which offers universal access to health care, has faced increasing pressure. The system has made a strong effort to counteract the pandemic, but this has had wider implications: the Italian NHS had to stop most elective care during the first phase of the emergency and still in 2021 and 2022 volumes of activity have not returned to pre-pandemic period.
The expected recovery of the services lost during the pandemic phase has not been registered and this is of particular concern: a careful assessment of the clinical outcome is required as well as the detection of compromised or aggravated heath conditions, with respect to which the delayed assistance response is and would be inevitably less effective, more complex and more onerous in terms of dedicated resources.
The drop in healthcare volumes due to pandemic crisis (and the aftermath of the pandemic) makes the health waiting list phenomena – which is a usual fact in the countries with a National Health System and represents, in some ways, a method for managing the health services – harder to deal with.
Italian public healthcare spending is currently considerably less than that of the other OECD an G7 countries. In 2019, the ratios between public healthcare expenditure and GDP were 6.4% in Italy compared to 7.6% and 9.1% for the groups mentioned; in 2020 it increased to 7.4% compared to 8.4% and 10.5% in OECD and G7 countries. The ratio has progressively decreased to 6.3% in 2024.
These are the financial resources with which the NHS will have to face the increase in demand for services due to the aging of the population, the recovery of the important volume of services largely suspended/postponed during the pandemic crisis and the new projects envisaged by the National Recovery and Resilience Plan (PNRR).
In this context, it’s very well welcomed the Government’s decision to modify the so-called “spending cap” – introduced in 2012 as part of the provisions of the spending reviews – which prevent the Regions from making full use of the potential of the accredited private facilities (“private” here is related to the ownership of the means of production within the NHS and the public coverage). Since now, this cap made it difficult to straighten out the problem with waiting lists and offer a complete response do the demand of healthcare.
AIOP’s 3 main priorities for 2024
- In addition to the spending cap update, the Government has allocated specific founds for the management of the waiting list phenomena, allowing Regions to buy farther services from the private component of the NHS. AIOP effort will be to monitor the correct application of the measure and the effective use of this new amount to better satisfy the healthcare demand.
- Reimbursements for acute day surgery and inpatient hospitalizations are established by the Diagnosis-Related Groups (DRG) system, whereby procedures are reimbursed based on a “service-provision” basis, according to a predefined cost estimate. This estimate is outdated: it doesn’t account for how technology, innovation and scientific research contribute to a new development in the clinical practices and how the impact of inflation on the broader economy has driven up input costs in healthcare significantly. AIOP will be at the forefront of finding solutions to these problems which affect private hospitals only as public hospitals are reimbursed at the bottom of the list.
- AIOP is deeply committed to enhancing the value of our private hospitals staff and healthcare professionals: for this reason, one of our priorities is to align the contractual conditions of the private sector with those of the public sector, through the Government collaboration.