45 years of the National Health System. GIMBE's initiatives to relaunch it
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The National Health System (NHS) turns 45. The Italian model of universal healthcare, which has always been exemplary for the entire world, is however losing efficiency more and more rapidly. To restore it, the GIMBE foundation indicates critical points and solutions, and launches two initiatives. (1)
45 years of the National Health System
The 23 December 1978 Parliament approved by a very large majority law 833 which established the National Health Service (SSN) in implementation of the art. 32 of the Constitution. Inspired by principles of equity and universalism and financed by general taxation, the Italian healthcare system represents an exemplary public healthcare model, which has made it possible to protect the health of the population.
A model also included in the Sustainable Development Goals (SDGs): Achieve Universal Health Coverage (UHC) by 2030. (2)
Politics However, the national system has demolished, legislature after legislature, the original system of the NHS, as attested by the inefficiencies that anyone can experience.
'The daily life of people, in particular the less well-off, is increasingly conditioned by the lack of enforceability of a fundamental right, that of health protection:
– interminable waiting time for a health service or a specialist visit,
– need to resort to private spending until the impoverishment of families and gives up treatment,
first aid very crowded,
– inability to find a family doctor or pediatrician near home,
– huge regional inequalities and local until healthcare migration', says Nino Cartabellotta, President of the GIMBE Foundation.
The #SalviamoSSN civic network and the national logo
At ten years old since the start of the #SalviamoSSN campaign, the GIMBE Foundation launches a national civic network with regional sections to involve more and more people in the protection and relaunch of the NHS based on principles of universality, equality, fairness to protect a constitutional right, and prevent it from degenerate into 21 regional health systems based on free market rules. (3)
To enhance identity Furthermore, the Gimbe Foundation hopes for the adoption of an official logo. The Presidency of the Republic, the High State Officials and the Ministry of Health were involved in this objective through a formal request sent on 4 December 2023.
The monograph on the NHS
To these and numerous other activities available on the site, the GIMBE Foundation adds the monograph 'The National Health Service turns 45. Long live the National Health Service!', a precious text that traces the causes of the collapse of the NHS and proposes solutions. (4)
The 'pathologies' of the NHS
GIMBE Foundation reels off the 'pathologies' of the NHS with a wealth of details and numbers, revealing to the citizen the reasons for the increasingly worrying disservices.
1) Inadequate financing of the Italian NHS
Inadequate financing of the National Health Service has continued for fifteen years. Over the last 15 years all governments, of all colours, have cut resources or not adequately funded the NHS. As,
– in 2022 Italy will exceed only the countries of Southern Europe (Spain, Portugal, Greece) and those of Eastern Europe, except the Czech Republic, in terms of public health spending per capita,
– compared to the average of European countries, however, the Italian healthcare system is currently underfunded by 47,3 billion euros,
– accumulating the differences accumulated in the period 2010-2022 the figure reaches approximately 333 billion euros.
1.1) Insignificant funds
The current financing of the National Health Fund is inadequate to relaunch the NHS. Involution is well represented in the GIMBE monograph.
– In the years 2020-2022 the FSN grew by €11,6 billion, compared to €8,2 billion in the decade 2010-2019. However, the huge resources were entirely absorbed by the pandemic emergency and did not make it possible to structurally strengthen the NHS, nor to keep the Regions' accounts in order.
– At the start of the XIX Legislature (Meloni government, from 13.10.22), with the 2023 Budget Law the government increased the FSN by €2,15 billion for 2023 (of which €1,4 billion absorbed by the energy crisis), by €2,3 billion for 2024 and €2,6 billion for 2025.
These figures are negligible, also considering the inflation rate which in September 2023 was 5,7%. Furthermore, no program to relaunch investments can be seen in the medium term. In the update note to the DEF (NaDEF) of September 2023, the health expenditure/GDP ratio drops from 6,6% in 2023 to 6,2% in 2024, reaching 6,1% in 2026, well below the value pre-pandemic of 2019.
– The 2024 Budget Law the FSN is expected to increase by €3 billion for next year, €4 billion for 2025 and €4,2 billion for 2026. However, despite the clear increase in the FSN in 2024, no progressive revival of public financing is in sight for public health. In fact, approximately €2.400 million will be allocated to the contractual renewal of employed and affiliated healthcare personnel, and the increases expected in 2025 (+1%) and 2026 (+0,15%) are so small that they will not even be able to compensate for the inflation, nor the increase in prices of goods and services.
Source: GIMBE
2) Lack of staff
The lack of resources continues to weaken the NHS in its structural, technological, organizational and, above all, professional components.
'To pay the expenses in fact, it was above all healthcare personnel who were affected by the progressive defunding. The persistence of the spending cap referred to as far back as 2004 first reduced the quantity of doctors and especially nurses, then progressively demotivated them so much so that today early retirements, voluntary dismissals, flights to the private sector or abroad are multiplying', remarks Cartabellotta.
3) Regional inequalities
Equality and fairness which animated the creation of the NHS 45 years ago are pulverized by the evolution of 21 unequal regional health services.
In most of the southern regions not even the essential levels of assistance (LEA) are guaranteed. The 2021 monitoring of LEAs by the Ministry of Health documents that of the 14 compliant Regions only 3 are in the South (Abruzzo, Puglia and Basilicata), all at the bottom of the rankings.
'And it hangs on this fracture the ax of differentiated autonomy, which without defining and financing the Essential Levels of Services, will only amplify inequalities, normatively legitimizing the North-South divide and violating the principle of equality in the right to health protection and dealing the final blow to the NHS', comments the president of the GIMBE Foundation.
4) Health migration
The consequence of the 'North-South structural fracture' it is the growth in the migration of citizens from the southern to the northern regions in search of healthcare.
The phenomenon is worth 4,24 billion euros (2021), which flow from the South to 3 northern regions where 93,3% of the credit balances are concentrated. Precisely the same Regions (Emilia-Romagna, Lombardy, Veneto) that have already signed the pre-agreements for greater autonomy.
In 2021, in fact, the Regions with positive balance above €100 million are all in the North:
– Emilia-Romagna (€442 million),
– Lombardy (€271 million),
– Veneto (€228 million).
The Regions with a negative balance greater than €100 million are all in the Centre-South:
– Abruzzo (-€108 million),
– Puglia (-€131 million),
– Lazio (-€140 million),
– Sicily (-€177 million),
– Campania (-€221 million),
– Calabria (-€252 million).
5) Waste and inefficiencies
'The provision of healthcare today it is very fragmented, too medical-centric, dichotomized between hospital and territory and poorly integrated with the socio-healthcare one, generating waste and inefficiencies, reduced quality of services and inconvenience for patients', recalls Cartabellotta.
Waste and inefficiencies they are not missing. Think about it
– excess performance from defensive medicine,
– fraud,
– purchases at excessive costs,
– administrative complexities,
– inadequate coordination of care, in particular between hospital and local settings.
These critical issues deserve recovery action, but their recovery is certainly not sufficient to restore the NHS.
6) Expansion of the accredited private sector
Private healthcare facilities accredited continue to increase, thanks to the lack of efficient public assistance.
Now they present
– almost half of those that provide hospital care (48,6%),
– 60,4% of those for outpatient specialists,
– 84% of facilities intended for residential care,
– 71,3% of structures intended for semi-residential care,
– 78,2% of rehabilitation facilities. (5)
Source: GIMBE
Let's save the NHS
'On the occasion of his 45th birthday with our initiatives we want to reiterate to the population the inestimable value of the NHS and the mandatory need for a social and political pact which, regardless of party ideologies and changes in governments, recognizes that healthcare model as a pillar of our democracy, an indispensable achievement and a great lever for the economic development of the country. As well as an alliance between all healthcare stakeholders aimed at renouncing acquired privileges to relaunch this precious common good in the exclusive interest of people', concludes Cartabellotta.
Marta Strinati
Note
(1) GIMBE Foundation. The National Health Service turns 45. GIMBE launches the civic network #SalviamoSSN and asks President Mattarella for a logo for the NHS. Bitter birthday "party" with the ax of differentiated autonomy. 19.12.23 https://www.gimbe.org/pagine/341/it/comunicati-stampa
(2) Dario Dongo, Sabrina Bergamini. Universal health coverage, UN declaration. Égalité. 22.2.20
(3) To join the civic network, fill out the form at this link https://salviamo-ssn.it/salviamo-ssn/rete-individui.it-IT.html
(4) Nino Cartabellotta. 'The National Health Service turns 45. Long live the National Health Service!' https://salviamo-ssn.it/var/contenuti/Monografia_SSN45.pdf
(5) Statistical Yearbook of the National Health Service 2021. Ministry of Health https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=3299
