“Italians second in Europe for life expectancy, but too many sedentary people”

In Italy, per capita healthcare spending is still below the European average, doctors are the oldest in Europe and nurses ‘flee’ abroad. Good news for citizens: they can aspire to a long life, even if a sedentary lifestyle remains a bad habit to be eliminated. These are the main elements concerning Italy that emerged from the report ‘Health at a Glance: Europe 2024’ of the OECD. Going into detail, in Italy both health spending per capita and health spending in relation to GDP remain lower than the EU averages in 2022. Health spending per capita was equal to 2,947 euros in 2022, about a sixth below the average EU of 3,533 euros. Same goes for the health spending in relation to GDP: also in 2022 it was positioned below the EU average, with a share of 9%, compared to 10.4%. Preliminary estimates for 2023 indicate that total health spending per capita in our country has decreased year-on-year by almost 4% in real terms, reflecting a 4.5% decline in public spending and a 2.6% decline in direct. “The Covid pandemic has put upward pressure on healthcare spending across the EU and, although Italy is no exception, its healthcare spending has increased at a more moderate pace than in most other EU countries ”, the authors of the report analyze in a note.

Little is invested in long-term care

The composition of health spending by source of financing reveals that public health spending overall represents three-quarters of total spending in Italy, a share lower than the EU average of 81%. In contrast, direct (out-of-pocket) spending represents 23% of total spending, a higher percentage than the EU average of 15%. Between 2019 and 2021, the Covid emergency increased per capita healthcare spending by 9.3% in real terms. However, 2022 saw a normalization of spending levels with a decline of 3.5%, accompanied by a similar decrease in direct spending. Looking in detail at the items in which investments are made, Italy stands out for a slightly higher than average budget allocation for outpatient care services (33% versus 29%). The country, however, allocates a relatively low share to long-term care, equal to just under 10% of total health spending in 2022, below the EU average of 15%. “This relatively small allocation largely reflects Italy’s historic reliance on informal care, despite having one of the oldest populations in Europe,” the report’s authors add.

Italian doctors are the oldest in Europe

From the same Report it also emerges that Italian doctors are the oldest in the EU. A ‘record’ that goes hand in hand with the trends of the Italian population: almost 25% are in fact over 65 years of age in 2023, the highest percentage in the Union together with Portugal, and it is expected that this share will reach over 33% by 2050. With an aging population, “the demand for healthcare services in Italy will continue to grow,” warn the authors of the report in a note. “Compounding this challenge” is the fact that “the Italian medical workforce is the oldest in the EUwith over half of Italian doctors aged 55 or over and 27% aged 65 or over, the highest percentage in the Union”. Obviously what is frightening is the impact of the ‘pension hump’ for the white coats. In Italy the wave of retirements is expected to peak in 2025 and “will only normalize at the end of the decade”, experts warn. The current situation in Italy could be summarized as follows: it has a number of doctors per population similar to the EU average – 4.2 per thousand inhabitants – but a number of nurses lower than the average (6.5 compared to 8.4 per thousand inhabitants in EU). There is increased dependence on doctors for the provision of healthcare services. But, the authors analyze, “with the approach of a considerable number of retirements in the medical sector and the increase in the need for care services linked to demographic aging”, some factors “may contribute to mitigating the demand for medical personnel”. Those that are mentioned are “the expansion of the skills of family and community nurses, together with those of pharmacists”.

Nurses below the EU average due to vocational crisis

Between vocational crises and escapes abroad, nurses in Italy are ‘in short supply’. According to data reiterated by the OECD’s ‘Health at a Glance: Europe 2024’ report, Italy has a number of nurses below the EU average: 6.5 compared to 8.4 per thousand inhabitants in the EU. The profession in Italy is facing critical issues, which further aggravate the general crisis of human resources in the healthcare sector, warns the report. “Applications to enroll in nursing training courses have almost halved since 2012, despite a 25% increase in the number of places available,” the authors of the report report in a note. Consequently, the number of Nursing graduates in Italy “remains one of the lowest in the EU in relation to the population (16.4 versus 37.5 per 100 thousand inhabitants in the EU in 2022)”. Added to this trend, the report finally points out, is the emigration of Nursing graduates in search of more advantageous salaries abroad, and all this “raises concerns about Italy’s ability to fill future nursing positions – explain the experts -. Expanding the role and improving the quality of working conditions for nurses are key to attracting more people to this profession.”

Italians can aspire to a long life

If the Covid pandemic had affected the longevity of the Italian population, now, as shown by the OECD Report, they seem to have one of the highest life expectancies in Europe. In 2023, a child born in Italy could expect to live on average 83.8 years: the second highest in the Union, just after Spain, and 2.5 years above the EU average. After an above-average decline of 1.3 years due to Covid deaths in 2020, Italy’s life expectancy began to recover and slightly exceeded pre-pandemic levels in 2023, aligning with the trend observed in most other European Union countries. As in other European countries, too in Italy men have a lower life expectancy than women. In 2022 – the OECD notes – the life expectancy of Italian women was 84.8 years, more than four years more than men (80.7 years). But they are not always quality years: as happens in other EU countries, Italian women spend a greater percentage of their lives with health problems and activity limitations (20%) compared to Italian men (17%), hence the gap of gender in the years of healthy life is almost zero (less than one year).

Italians are too sedentary

Then there is the impact of a sedentary lifestyle. The OECD report shows that the Italian population has one of the lowest rates of physical activity among EU countries. In 2019, only 19% of adults reported meeting the World Health Organization (WHO) recommended minimum level of at least 150 minutes of physical activity per week. This figure, the report notes, “is alarming when compared with the EU average of 32%”. The problem is even more pronounced among older adults in Italy. Less than 10% of over-65s meet these guidelines, placing the country in the bottom third of EU countries for this age group, compared to the EU average of 22%. Things are no better among the very young: in 2022, Italy recorded the smallest percentage of 11 and 15-year-old children meeting the WHO recommendations on daily physical activity among EU countries. Only 11% of 11-year-olds adhered to these guidelines, while the percentage fell to 5% among 15-year-olds. “These data – we read in a note on the report – outline an alarming picture, as they suggest that physical inactivity is destined to persist and even worsen in the future in the absence of effective measures to combat it”. The consequences of this widespread lack of physical activity? “They are far-reaching and expensive – conclude the authors of the report -. OECD models estimate that between 2022-2050, insufficient physical activity in Italy will cost the country 1.3 billion euros per year in additional healthcare costs. This significant economic burden highlights the urgent need for action to promote physical activity across all age groups.”

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What specific strategies can be implemented to address⁢ the challenges highlighted in the OECD‌ report regarding Italy’s ​healthcare system?​

1. What are the main challenges currently facing the healthcare system in Italy as⁤ highlighted in the ‘Health at a Glance: Europe 2024’ ⁤report by the OECD?

2. How does Italy’s per capita healthcare spending and​ health spending in relation to GDP compare to the European‌ average? What factors‍ contributed to this situation?

3. What are the major ‌causes of Italy’s lower per capita healthcare spending compared to other European countries?

4. What are the implications of⁣ having the oldest medical workforce in Europe? How is Italy addressing‍ this issue?

5. What are the reasons behind the ‌shortage of nurses in‍ Italy and how is this crisis affecting the healthcare industry?

6. Despite having one of the lowest rates of physical activity among EU countries,⁣ why do you think Italians can hope to have a relatively long ⁤life expectancy?

7. What role does public health spending play ⁢in ensuring quality healthcare in Italy? How can the government improve public health policies to ⁣boost economic growth and reduce healthcare costs in the long run?