Current Problems and the
Financial Sustainability of the
Italian Health Care System
Vincenzo Atella
Health Econometrics, Economics and Policy (HEEP)
Outline of the presentation
 The
context of public finance in Italy and
abroad
 The
effects of auterity policies (desired
and undesired) on public health
expenditure
 The
financial sustainability of the NHS
2
# of countries with reduction in public
expenditure in % of GDP, 2008-15
Fonte: Ortiz e Cimmins (2013), Authors’ calculations based on the IMF’s World Economic Outlook (October
2012)
3
Fonte: Ortiz e Cimmins (2013), Authors’ calculations based on the IMF’s World Economic Outlook (October
2012)
4
-10.0
-5.0
Fonte: OECD Health at A Glance Europe, 2012
-1.2
1.8
3.1
2.9
2.0
1.4
1.6
4.2
2.4
2.0
2.7
3.5
3.6
2.0
3.1
2.2
1.2
3.9
3.8
3.4
2.2
2.1
0.8
1.3
1.0
0.5
0.5
0.4
0.2
0.1
2.7
5.6
5.5
4.9
4.6
4.1
7.1
10.9
Health spending 2009-2010
-2.0
-0.2
-0.5
-0.6
-0.9
3.9
3.2
5.0
-2.0
-2.1
6.0
8.9
10.0
-4.4
-5.0
5.7
7.2
6.5
Health spending 2000-2009
-7.1
-6.7
-7.3
-7.9
Annual average growth rates, real terms
GDP and Health care spending in OECD
countries
GDP growth 2009-2010
15.0
2.5
2.0
1.5
1.0
0.5
0.0
0.0
-0.5
-1.0
-1.5
-2.0
5
Rate of growth of health care spending in OECD
countries
Health: 2° most important
component in public exp in Italy
36
32
28
(% of total public expenditure)
24
20
16
12
2007
2010
8
4
0
Source: OECD Fiscal Consolidation Survey 2012.
7
Public finance intervention in Italy
(up to March 2013)

From June 2008 to present, we have launched fiscal
interventions for a total of 137 billion euro.

In 2012, we
interventions.

In 2013 have been decided additional fixes for more
than 26 billion euro.

Only in 2014 we expect a loosening of the austerity,
with an additional cut under 6 billion Euros.

Despite this massive effort in terms of corrective
measures, the past legislatures leave an inheritance
that does not deliver the achievement of a balanced
budget.
had
almost
60
billion
Euros
of
8
A synthesis of recent policy interventions
on the NHS
A synthesis of recent policy interventions
on the NHS
Trend in public health financing
Fonte: Elaborazioni Fondazione Farmafactoring su Documenti Ufficiali
11
The role of regional revenues
2011
Regioni con
PdR
Risorse proprie
Milioni di euro
Leva fiscale
Totale
Risorse proprie
in % del
Leva fiscale
finanziamento statale
Totale
Risorse proprie
Leva fiscale
in % dei costi
Totale
1.614,2
1.916,0
3.530,2
3,3
3,9
7,2
3,1
3,7
6,8
Regioni
senza PdR
3.413,5
108,5
3.521,9
6,0
0,2
6,2
5,6
0,2
5,8
Totale
5.027,7
2.024,4
7.052,1
4,7
1,9
6,6
4,5
1,8
6,3
Fonte: elaborazioni Fondazione Farmafactoring su dati Min. Salute (2012) e Corte dei Conti (2012)
12
OOP expenditure as % of public
expenditure - 2011
Fonte: Elaborazioni Fondazione Farmafactoring su Documenti Ufficiali
13
SOME UNPLEASANT EFFECTS OF
COST CONTAINMENT POLICIES
14
Where we continue to spend
15
Fonte: elaborazioni Farmafactoring su dati HS-SiSSI e Ministero della Salute.
Where we continue to spend
Regions WITHOUT PdR
Regions WITH PdR
Fonte: elaborazioni Farmafactoring su dati HS-SiSSI e Ministero della Salute.
16
THE FUTURE SCENARIOS
17
Comparison across simulations of
public health expenditure
18
Fonte: CEIS Tor Vergata, Unione Europea, RGS, IMF, OCSE
Real public health care expenditure
growth rates (1985-2010)
Anni
1985 - 1990
1991 - 1995
1996 - 2000
2001 - 2005
2006 - 2010
1985 - 2000
2001 - 2010
1985 – 2010
D
(mln euro)
3.489,0
-1.067,9
3.355,8
3.339,4
1.168,1
1.925,6
2.253,8
2.056,9
(%)
6.81%
-1.56%
5.30%
4.17%
1.21%
3.76%
2.81%
4.02%
Fonte: elaborazioni CEIS Tor Vergata su dati Ministero della Salute.
19
Δ of public expenditure by type
of simulation
(Values in Bls of euro)
Nominal values
2010
2050
Δ year
CEIS 1 20102050
113.8
336.9
5.44
CEIS 2 20102050
113.8
444.7
8.06
RGS 2011-2050
113.7
548.4
10.9
Real values 2010
2010
2050
Δ annuo
CEIS 1
113.8
121.3
0.18
CEIS 2
113.8
160.1
1.12
RGS
113.1
197.4
2.06
20
Fonte: elaborazioni CEIS Tor Vergata su dati Ministero della Salute.
Conclusions

There is a clear general trend to reduce government
spending, in particular in the health care sector.

The outlook for the coming years in terms of available
resources does not seem to be so rosy.

The effects of the cuts on the different segments of the
population will certainly not be neutral.
21