Economy. Government spending for health care collapses. France and Germany allocate €4,000 of public spending per inhabitant, Italy just over €2,000.

Huge cuts in the Italian health service

In 2014, Italy’s health spending was “significantly lower” than that of other EU countries, both in terms of per capita expenditure and in relation to GDP. This was certified yesterday, when the Istat provided data of the 2012-2016 period.

Italy spent about €2,404 euro per capita while the UK, France and Germany have allocated between €3,000 and 4,000 per inhabitant; Denmark, Sweden and Luxembourg spent around €5,000. In relation to GDP, the expenditure was close to 11 percent in France and Germany, just under 10 percent in the UK and about 9 percent in Italy and Spain.
In 2016, the current health expenditure amounted to €149.5 billion (€2,466 per capita), equal to 8.9 percent of GDP, 75 percent was covered by the public sector. The private health expenditure in 2016 amounted to €37.318 billion, equal to 2.2 percent of GDP, out of which 90.9 percent was paid by the families. Spending on care and rehabilitation amounted to €82.032 billion, accounting for 54.9 percent of total health expenditure and 4.9 percent of GDP. While pharmaceutical products and therapeutic devices for €31.106 billion are equal to 20.8 percent of the total.

The hospitals are the main providers of healthcare, accounting for 45.5 percent of the total current expenditure. In second place, outpatient clinics, which account for 22.4 percent. In third place, there are long-term care facilities, which accounts for 10.1 percent.

The CGIL warns: “We must unmask the ongoing game on the national health service: no one says it needs to be changed, but it is being changed, by building another system where those who have the means will get care in private facilities and the public healthcare service plays a residual role for the poor”, said Susanna Camusso in Rome yesterday, and closing the conference added “a strong, high quality, public health service for all.”

This one-day debate served to build a platform shared with CISL and UIL to reopen the negotiations with the government. The event was started by Rosy Bindi, Minister of Health between 1996 to 2000, who explained: “We have to build a social, cultural and political movement of significance on the most important public infrastructure created in Italy in the ’70s.”
At the top of the trade unions’ platform priorities, are resources: the economic and financial document for 2019 shows a ratio healthcare-GDP spending of 6.4 percent, however it is necessary to bring the investment up to the average in the first fifteen EU countries.

And the savings from the rationalization of expenditure must be reinvested in the sector, the regional funding needs to be updated. Today it is based on average age: the higher the average, the most funds are allocated (so Liguria gets more than Campania, which has the lowest average age in the country).

The distribution must be balanced with the incidence of economic and social difficulties and the epidemiological situation. Another crucial point are supertickets (prescription fees). “Their weight has become unbearable, even the Court of Auditors agree,” explains the CGIL. Their proliferation and the differences among the regions have generated distortions: recurring to the private healthcare sector, renouncing to care, health emigration to other regions.

The result was a lower revenue for the public sector, that is, a new element in its progressive dismantling. The same goes for the waiting lists.
In the regions under the repayment plan, linear cuts have shaken the service, Camusso criticized the commissioners’ management: “A gigantic move not to take political responsibility and escape the normalization of operations.” To get out of it, it is necessary to fight corruption and waste, verify the accredited centers where often a protected market is created, to the detriment of the public, and monitor the implementation of the essential levels of care.

In short, it takes a new organization that takes into account gender differences, more prevention, the integration between health and social services and public investment in innovation. It is critical to change the policy of closed numbers in public universities which is favoring private universities financed by businesses and drug industries.
Camusso dedicated a section of the debate to the theme of work in health care: “The run-up to the private sector was accompanied by the devaluation of the public sector, all the employees were defined as parasites. A hierarchy was established: in the same structure, different actors coexist: the employee of the subcontractor, the employee of the cooperative called to the rescue, who are considered different from the public worker. They have lower salaries, variable duties based on the tender amount, worse contractual conditions and lack of recognition. The outsourcing, then, only caused a higher spending.”

The CGIL therefore asks to overcome the lack of security, “safeguarding and increasing employment levels, renewing and abiding by contracts, overseeing the tender process.”

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