Current%20Problems%20and%20the%20Financial%20Sustainability%20of%20the%20Italian%20Health%20Care%20System

1
Current Problems and the Financial Sustainability
of the Italian Health Care System

• Vincenzo Atella
• Health Econometrics, Economics and Policy (HEEP)

2
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

3
of countries with reduction in public
expenditure in of GDP, 2008-15
Fonte Ortiz e Cimmins (2013), Authors
calculations based on the IMFs World Economic
Outlook (October 2012)
4
Fonte Ortiz e Cimmins (2013), Authors
calculations based on the IMFs World Economic
Outlook (October 2012)
5
GDP and Health care spending in OECD countries
Annual average growth rates, real terms
Fonte OECD Health at A Glance Europe, 2012
6
Rate of growth of health care spending in OECD
countries
7
Health 2 most important component in public exp
in Italy
( of total public expenditure)
8
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 had almost 60 billion Euros of
  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.

9
A synthesis of recent policy interventions on
the NHS
10
A synthesis of recent policy interventions on the
NHS
11
Trend in public health financing
Fonte Elaborazioni Fondazione Farmafactoring su
Documenti Ufficiali
12
The role of regional revenues
13
OOP expenditure as of public expenditure - 2011
Fonte Elaborazioni Fondazione Farmafactoring su
Documenti Ufficiali
14
Some unpleasant effects of cost containment
policies
15
Where we continue to spend
Fonte elaborazioni Farmafactoring su dati
HS-SiSSI e Ministero della Salute.
16
Where we continue to spend
Regions WITHOUT PdR
Regions WITH PdR
Fonte elaborazioni Farmafactoring su dati
HS-SiSSI e Ministero della Salute.
17
The future scenarios
18
Comparison across simulations of public health
expenditure
Fonte CEIS Tor Vergata, Unione Europea, RGS,
IMF, OCSE
19
Real public health care expenditure growth rates
(1985-2010)
Fonte elaborazioni CEIS Tor Vergata su dati
Ministero della Salute.
20
? of public expenditure by type of simulation
(Values in Bls of euro)
Nominal values
2010 2050 ? year
CEIS 1 2010-2050 113.8 336.9 5.44
CEIS 2 2010-2050 113.8 444.7 8.06
RGS 2011-2050 113.7 548.4 10.9
Real values 2010
2010 2050 ? annuo
CEIS 1 113.8 121.3 0.18
CEIS 2 113.8 160.1 1.12
RGS 113.1 197.4 2.06
Fonte elaborazioni CEIS Tor Vergata su dati
Ministero della Salute.
21
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.