Rome, 4 November 2024 – The healthcare bills don’t add up. Analyzing the 2025 budget, 19 billion are missing from the measures envisaged from today until 2030, while in 2027 public financing falls below 6% of GDP, marking the historic minimum. But that’s not all. The annual increase in the Health Fund remains below the 2.6% recommended by the OECD. These are the main critical issues that emerged from thehearing of the Gimbe Foundation at the joint Budget Committees of the House and Senate. I criticize the president Nino Cartabellotta, who urged us not to use healthcare as a political battleground and put forward concrete proposals for the refinancing of the National Health Fund.
Cartabellotta: “Insufficient resources in the 2025 budget”
Cartabellotta does not use half measures: “The ways in which the amounts are presented are misleading: only the cumulative increases of the National Health Fund are reported, rather than the resources added annually, with the related redetermination of the FSN”. According to Cartabellotta “the draft Law on Maneuvering 2025 it’s a lot away from public health needs: the resources allocated are not enough to revive a National Health Service in serious trouble, they are largely insufficient to finance all the measures envisaged by the budget and relevant priorities for maintaining public health are missing”.
In particular, the Foundation highlights how the growth of the National Health Fund is clearly insufficient with respect to the difficulties of public health in guaranteeing the right to health protection in an equitable manner. “The increase of 2.5 billion euros for 2025, which brings 1.2 billion ‘as a dowry’ from the 2024 budget – explains Cartabellotta – increases the National Health Fund to 136.5 billion, in fact only by 1% compared to what has already been set in 2024″. And in the following years, except for 2026 (+3%), the percentage increases are minimal: +0.4% in 2027, +0.6% in 2028, +0.7% in 2029 and +0.8% in 2030.
National healthcare requirement graph (source: Gimbe Foundation)
National Health Fund in constant decline
“It clearly emerges reduction in investments in healthcare compared to the wealth produced from the country – comments Cartabellotta –, a sign that the strengthening of the National Health Service and health protection are not a priority even for the current Government”. In fact, in terms of percentage of GDP, the National Health Fund drops from 6.12% in 2024 to 6.05% in 2025 and 2026, and then falls to 5.9% in 2027, 5.8% in 2028 and to 5.7% in 2029. A trend which, as the president of the Foundation observes, “reflects the continued disinvestment from public healthstarted in 2012 and perpetrated by all governments. The progressive increase of the National Health Fund in absolute value, increasingly heralded as a great achievement, is actually one mere illusion. And with the 2025 budget it even goes down below the psychological threshold of 6%, reaching an all-time low”. Moving on to the analysis of the measures provided for by the art. 47 of the 2025 Budget, the Foundation highlights the clear gap with the allocated resources. In the period 2025-2030, the overall cost of the measures amounts to 21,365 million, to which must be added the contractual renewals of healthcare personnel, not reported in the text of the Budget. Costs that the Gimbe Foundation has estimated at 7,649 million: 3,618 million for the three-year period 2025-2027 and 4,031 million for 2028-2030. “Calculator in hand – observes Cartabellotta – the measures envisaged by the Budget for the period 2025-2030 have an overall impact of over 29 billion, while the resources allocated amount to approximately 10.2 billion. With a gap that is close to 19 billion and an NHS already in serious trouble, it is obvious that even the most virtuous Regions will struggle to implement the measures established by the Budget and will have to cut services or increase regional taxes”.
National healthcare requirement graph (source: Gimbe Foundation)
“Crucial priorities excluded from the Maneuver”
From the 2025 budget, according to Cartabellotta, they remain crucial priorities for the maintenance of the National Health Service are excluded such as the extraordinary plan for hiring doctors and nurses, the abolition of the spending cap on staff and adequate resources to restore attractiveness to the NHS, given that the specific allowances are only crumbs. There is also a lack of resources to reduce/abolish the payback on medical devices and to manage the continuous exceeding of the direct pharmaceutical spending ceiling, which is increasingly weighing on the pharmaceutical industry. Finally, even the ‘new’ Lea for specialist and prosthetic services, expected for 8 years, risk being postponed beyond 1 January 2025, due to the scarcity of the resources allocated.
According to the OECD report on the fiscal sustainability of health services, published in January 2024, healthcare spending will “physiologically” grow by an average of 2.6% per year until 2040, driven by the growing cost of drugs and healthcare technologies, an aging population and inflation. “Unfortunately – explained Cartabellotta – the increases envisaged by the 2025 Budget, well below this threshold, will not be sufficient to maintain the pace, leaving our NHS further and further behind”. In fact, with the funding allocated by the 2025 Budget Law, from 2026 we will move away from the growth rate of 2.6% per year, accumulating a gap of around 12 billion in 2030.
Gimbe’s “recipe”.
Cartabellotta believes “it is essential to start a progressive refinancing accompanied by courageous system reforms” to relaunch the National Health Service. Because adding funds without reforms reduces the value of health spending, while making reforms “without greater burdens on public finances” only creates “empty boxes”. The GIMBE Foundation then presented concrete proposals to refinance the NHS: first of all, increase resources for healthcarereallocating them from other chapters of public spending or introducing specific taxes, in particular on products that damage health (cigarettes, alcohol, gambling, sugary products). Secondly, reevaluate the boundaries between public spending and private spending: after updating the essential levels of assistance (the services that the NHS is required to provide to everyone free of charge or with the payment of copays), implement a “healthy reform” of supplementary healthcare that allows health needs to be covered by increasing intermediated spending and reducing the amount paid by citizens (out-of-pocket); review healthcare spending sharing; incentivize them public-private partnership. Finally, implement a national plan that allows us to avoid waste and inefficiencies to increase the value of healthcare spending.
