GIMBE Report: Private Health Spending Grows, But 40% Is Useless
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Private healthcare spending by Italian families exceeded 2023 billion euros in 40, according to the GIMBE Report, which highlights the need to increase the value of public healthcare spending, reduce waste and guarantee equal access to care, while preserving the founding principles of the NHS.
The GIMBE report analyses private healthcare spending in Italy in 2023, highlighting the critical issues of the National Health Service (SSN) and the dynamics of healthcare spending.
Health spending in Italy in 2023
Health care spending in Italy in 2023 it was a total of 176,1 billion euros, of which:
- 130,3 billion (74% of the total) of public spending (SSN)
- 45,8 billion in private healthcare, divided into:
– out of pocket, that is, directly supported by families, equal to 40,6 billion (88,6% of private spending)
– intermediated, that is, partially reimbursed by insurance companies, for 5,2 billion (11,4% of private spending).
Public health spending below the European average
Public spending on healthcare in Italy is decreasing compared to the European average, with a gap of 697 dollars per capita compared to OECD countries.Since 2012, cuts and defunding made by all governments have directly impacted the ability of the NHS to respond to the health needs of the population', recalls the GIMBE Report.
In other words, Italy spends 6,2% of its GDP, compared to the OECD average of 6,7% and the EU average of 6,6%.
Private spending above OECD average
Private healthcare spending The per capita income of Italians amounts to 1.258 dollars, exceeding both the OECD average (1.206 dollars) and the EU average (1.169 dollars).
The most important share It is represented by citizens' out-of-pocket expenditure: 1.115 dollars per capita, well above the OECD average (906 dollars).
Out-of-pocket spending increased by 26,8% from 2012 to 2022, with an average annual increase of 2,5%.
40% of private spending is for inappropriate services
The main voices of out-of-pocket spending includes health care for treatment and rehabilitation (44,6%), pharmaceuticals (36,9%), and long-term care (10,9%). However, about 40% of spending is considered low value, meaning it does not contribute to improving health.
Out-of-pocket spending it is however slowed down by serious phenomena such as
– limiting health expenses (15,7% of families in 2023),
– temporary economic unavailability (5,1% of families) and
– the renunciation of treatment (4,5 million people in 2023, of which 2,5 million for economic reasons), such as highlighted from Eurispes.
Spending through health insurance
The intermediated expenditure from insurance (143 dollars per capita) is lower than the OECD average (299 dollars). Overall in Italy it is worth 5,2 billion, equal to only 3% of total health expenditure.
The total amount for the 31,6 % it is destined to management costs, while the 70 % is used for services and performances. The crisis of the NHS has shifted an increasing number of health needs towards supplementary healthcare, putting its sustainability at risk.
The real value of health spending
The GIMBE Report adopts a value-based healthcare approach, highlighting that the health return on resources invested in healthcare is highly variable:
– approximately 19% of public spending is absorbed by waste and inefficiencies,
– 40% of out-of-pocket spending is low value
– 60% of the intermediated expenditure, on the other hand, is destined for extra-LEA services and benefits and therefore has a higher value.
Conclusions
The sustainability of the NHS requires a structural rethinking and courageous reforms, concludes the GIMBE Report. Out-of-pocket spending cannot be simply reduced through an increase in intermediated spending, but requires a increase in public funding, better appropriateness of services and a remodulation of the Essential Levels of Assistance (LEA).
Supplementary healthcare can only be sustainable if integrated in an effective NHS, otherwise it risks collapsing together with the public system, worsening inequalities and injustices.
Marta Strinati
References
GIMBE Observatory Report n. 2/2025. Private healthcare expenditure in Italy in 2023. GIMBE Foundation. Bologna, February 18, 2025. https://tinyurl.com/yeyr3rt3
