Videointervention by Dr. Nino Cartabellotta, President of GIMBE, at the presentation of the 2nd Report on the Healthcare System promoted by Eurispes and Enpam
The following are excerpts from the speech by Dr. Nino Cartabellotta, President of GIMBE, at the presentation of the 2nd Report on the Healthcare System, promoted by the Eurispes-Enpam Observatory on Health, Legality and Social Security. The video of the speech is available at the following link
«Do we still have the National Healthcare Service or do we have twenty-one Regional Healthcare Systems? The answer is, unfortunately, probably the latter. It is true that the 1978 founding law defined a series of requirements, above all the founding principles of universality, equity and equality. Principles strongly betrayed by the performance of the National Healthcare Service. Half of the Italian regions, mainly in the Centre-South, fail to provide essential assistance. We have public funding that as per capita expenditure is below the OECD average – ahead only of Spain, Portugal, Greece and Eastern European countries.
In my opinion, politics today must make a reflection by making a social pact, namely: which health service do we want to leave to future generations? It is clear that if we refer to the NHS established in 1978, we cannot go on. With 6.2% of GDP – which we spend on healthcare – we can only look at the WHO list of essential medicines rather than the great innovations that will arrive, on paper, but will not be equally distributed across the country. We often say that we have many centres of excellence in Italy, but these centres are only a fraction of the quality of the healthcare service in this country, because the quality of a service is measured by the equal accessibility of innovations to all citizens. Compared to other countries, we have a constitutional right to health protection in which all are equal. If this is not guaranteed, the system no longer works. If politicians do not have the courage to officially dismantle the National Healthcare Service, they are actually depriving it of oxygen – year after year, decade after decade – and we find ourselves here today discussing the fact that the NHS has been in code red for some time now.
The reflection is first and foremost political: do we want to relaunch the National Healthcare Service? We need a share of resources, which I cannot estimate at the moment, we expect a signal, a progressive financing that results in a revitalisation of public health and that should be read in the economic and financial document. Today we read that from 2024 to 2026 the expected average annual GDP growth is 3.6%, of healthcare it is 0.6%. Healthcare, for politicians, is worth one sixth of the country’s growth when, instead, we know that the level of health and wellbeing of a population is an independent variable of the country’s economic growth, not only because it provides employment but because if we are all better we can work more efficiently – we do not have to take care of sick relatives – the level of productivity increases.
This is a first model to reflect on. The second model is based on the desire to move towards free-market healthcare: we abandon the fair and universalistic public healthcare service – there is a world that wants to invest in healthcare – we decide what to take away from the essential levels of care. Incidentally, we have one of the lowest public funding in Europe, but we have the widest possible LEA basket.
What we need to invest mainly in is human capital. Human capital can work both in a fair and universalistic public system and in a partially privatised system.
Then, there is the issue of state-region governance. Although some have indicated GIMBE as centralist, I am convinced that going back to centralisation is neither organisationally feasible nor economically sustainable. The planning and management of health services must remain in the hands of the regions, but the State must increase its capacity for guidance and verification, because after the 2001 reform it no longer fulfilled its duty. All the central and southern regions have not recovered because they have been under recovery plans for fifteen years. Therefore, these governance systems we are using are obsolete and, paradoxically, we have proposed them again in the Institutional Development Contract of the National Recovery and Resilience Plan.
The last consideration, on the subject of the PNRR. It is obvious that the Plan was designed on the basis of the main criticalities – structural and technological deficiencies – but, allow me the joke, we are investing part of the PNRR money on what we should have paid for with current expenditure (equipment and anti-seismic). Explain to me why we have to go into debt to generate non-productive spending that does not provide value. Then there is the great reform of the organisation of the territorial system – so called because we should have reported it in the PNRR as a structural reform – which, however, in turn, requires many others to be implementable and at the moment remains only on paper. It is not by making a list of the standardisation – absolutely due and legitimate – of the territorial offer that we can change the way in which territorial services are regulated, also because we must not forget that the first obstacle, once again, is regional differences. One fact for all, but there would be many others: one of the objectives to be achieved by 2026 is to assist 10% of the population over 65. We will reach the target, but while Emilia Romagna must increase the number of assisted births by 17%, Calabria must increase them by 450%».