Abstract
The impact of the Italian expenditure for the health care on Gross Domestic Product (GDP) and on total public expenditure, is in line with those of the major industrialized countries, and somewhat lower than the European average. The issue of the Italian health sector is not simply related to the contraction of the expenditure: in effect, it should be highlighted that Italy currently does not spend “a lot” and, above all, invests “little” in the mentioned sector. Nevertheless, the health sector can be a very important flywheel for the economic recovery but, in order to make this possible, it is necessary to pay a lot of attention, and to invest the best resources. In this work, the authors intend to develop an analysis of the desirability of investment on Information and Communication Technologies (ICT) in the health sector, and the consequent compatibility with current expenditure, by identifying at the outset the channels multipliers related to the resources at present allocated to the current health expenditure and capital account.
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Notes
- 1.
EuroHealth Consumer index 2013 in http://www.healthpowerhouse.com/index.php?Itemid=55.
- 2.
It is worth paying attention to the details that are stressed in the report by the OECD Health Division prepared following a request for clarification from the Hygiene and Health Commission of the Italian Senate (the report has come in the first months of 2014 to the attention of parliamentarians) (http://www.quotidianosanita.it/allegati/create_pdf.php?all=1683299.pdf). The report underlines that in the current government, “the data provided in support of health care expenditure reductions proposed in the expenditure review does not allow you to fully appreciate the situation of increasing disadvantage of the National Health Service with respect to the health care systems of other European countries”. It is also highlighted that “Italy has a public health expenditure per capita more than a third lower than the average of other countries in the Eurozone considered in the expenditure review, and the gap has tripled since the early 2000 s”. But this is not enough. According to the OECD, “the level of health services provided in Italy is significantly lower than that observed in almost all other countries in the Euro area considered in the expenditure review”. For this reason “any expenditure reductions aimed not only for the recovery of inefficiencies would affect further on access to healthcare, on the levels and quality of health care, particularly for the most disadvantaged citizens”. Not to mention that the benchmark for the public health expenditure (5.25 % of GDP) suggested by the Working Group on the Review of public expenditure is not compatible with the existing model of the Italian National Health Service.
- 3.
By reading the history of the Italian health since 1978 (the date of creation of Italian national health system) one can easily notice how financial difficulties have been a feature of the system and have also been affecting the organization and the decisions of policy makers [1].
- 4.
According to the latest data presented by ISTAT, the Italian public health expenditure amount to 111 euro billion, that is 7 % of GDP: € 1867 year/inhabitant. But Italy is in the second half of the ranking of European countries in per capita expenditure, below France, England and Germany, that are our reference countries. Essentially, let alone other problems, the funding allocated to public health care is not sufficient. It is therefore unsurprising that a group of citizens, gathered by the Association Giuseppe Dossetti, has decided to promote a class action and to sue the State, because it does not guarantee the LEA, the essential levels of assistance in 12 regions out of 21. According to the data, it will ask for a compensation for not complying with the law and the “Patto sulla salute”. See http://www.sanita.ilsole24ore.com/art/dibattiti-e-idee/2014-02-10/dallassociazione-dossetti-class-action-130644.php?uuid=Ab0MKYMJ.
- 5.
The authors argue that the problem is not the sustainability of the system rather than its survival.
- 6.
An example is the industrial district wellness spa: http://ideario.formez.it/content/distretto-produttivo-del-benessere-termale-siciliano.
- 7.
A serious policy of investments in ICT, in fact, may generate significant improvements both from the point of view of the ability of care and with respect to containment of expenditure. For example, one of the cornerstones to a more effective and efficient health care system is digital innovation: according to the data, if the Italian health system realized completely the potential of digital technologies, it could save 6.8 billion a year—much more than the cuts expected in 2015 and 2016 for financing public health sector. In contrast to the cuts, however, “the digital” innovation would achieve transparency and appropriateness, would reduce many errors (just think of the interpretation of recipes written by doctors) and would improve the quality of services provided to citizens (think of the queues that could be avoided by allowing you to download the reports from home). Even if the investments to be implemented would be limited (we are speaking about millions of euros and not billions in the maneuvers of stability), Italy does not appear to be keen on digital healthcare. There are several ongoing trials but the total expenditure allocated to digitization is estimated to decrease as compared to 2011 and in proportion Italy spends a third in comparison with countries such as France or England. See the case of the Region “Marche”: http://www.ecommunity.marche.it/AgendaDigitale/tabid/174/Default.aspx.
- 8.
The key elements are: “an evaluation network that allows an effective monitoring capable of making the benchmarking technique a tool to control and effectively manage the system; a redesign of accounting rules that gradually helps to strengthen the reasons for a structural adjustment; a central government that, in comparison to the local government, accompanies the pursuit of cost containment interventions with structural adjustment, with improvements in equipment and with investments in human resources training”.
Report 2013 on the Coordination of the Public Finance—28.05.2013 in http://www.regioni.it/it/show-presentazione_del_rapporto_2013_sul_coordinamento_della_finanza_pubblica_-_28052013_/news.php?id=299026.
- 9.
This paragraph has been authored by Monica De Angelis.
References
De Angelis, M.: La complessità del sistema sanitario italiano: profili giuridici (in particular Chapter I) (2012)
Caruso, E., Dirindin, N.: Perché tagliare ancora una sanità già sostenibile? http://www.lavoce.info/perche-tagliare-sanita-gia-sostenibile/ (2014)
Ciaschini, M., De Angelis, M., Pretaroli, R., Severini, F., Socci, C.: The third age in the national health system: a proposal for increasing the spending effectiveness in health care for the elderly. In: Ambient Assisted Living: Italian Forum 2013, vol 9, pp 345–353. Springer-Verlag (2014)
De Angelis, M.: The expansion of patients’ rights in Europe: a new perspective for healthcare abroad. In: Bulletin of the Transilvania University of Brasov. Volume 7 of Series VII: Social Sciences Law (2014)
De Angelis, M.: La complessità dei sistemi sanitari. Problematiche giuridiche del caso italiano. Esculapio, Bologna (2012)
Dipartimento di Ingegneria Gestionale, Politecnico di Milano: Innovazione Digitale in Sanità: l’ICT non basta! Osservatorio ICT in Sanità (May 2014)
Ciaschini, M., Pretaroli, R., Socci, C.: Number 2/09 in Contenimento della spesa corrente e spesa in conto capitale nel sistema sanitario pubblico. In: Tendenze Nuove. Il Mulino pp. 115–132 (2009)
Socci, C., Ciaschini, M., Pretaroli, R., Severini, F.: Health services as a key sector for income and employment change. Bull. Transilvania Univ. Braşov 3, 163–172 (2010)
Ciaschini, M., Pretaroli, R., Socci, C.: Health-care in europe as a driving force for output and gdp. Glob. Forces Local Identity Econ. Cult. Divers. 28, 106–135 (2011)
Ciaschini, M., Pretaroli, R., Socci, C.: A convenient multisectoral policy control for ICT in the US economy. Metroeconomica 60(4), 660–685 (2009)
Ciaschini, M., Pretaroli, R., Socci, C.: Multisectoral structures and policy design. Int. J. Control 83(2), 281–296 (2010)
Ciaschini, M., Socci, C.: Final demand impact on output: a macro multiplier approach. J. Policy Model. 29(1), 115–132 (2007)
Ahmed, I., Ciaschini, M., Pretaroli, R., Severini, F., Socci, C.: Economic policy effects and financial crisis: a dynamic cge model for italy. In: 22nd International Conference of Input-Output, Lisboa, Portugal (14–18 July 2014)
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Ciaschini, M., De Angelis, M., Monteriù, A., Pretaroli, R., Severini, F., Socci, C. (2015). Investments and Sustainability of Public Expenditure in the Health Sector. In: Andò, B., Siciliano, P., Marletta, V., Monteriù, A. (eds) Ambient Assisted Living. Biosystems & Biorobotics, vol 11. Springer, Cham. https://doi.org/10.1007/978-3-319-18374-9_4
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