Hospitals in pieces and endless waits. The heavy bill of twenty years of cuts

It all starts with money. Which can be spent well or badly but remain the basis for ensuring quality healthcare for citizens. Unfortunately in Italy the public system has been defunded for some time, which with the centre-right government, by its own prediction, is destined to reach levels never seen before. Other problems arrive in cascade. Those that concern waiting lists and the consequent push of citizens towards the private sector, those linked to the structural problems of hospitals and also those of staffing.

Fewer and fewer funds

The treatment is financed by the National Health Fund. If you only look at that (in 2024 it is around 134 billion) you observe an increase from year to year and you don’t understand the situation. The Court of Auditors, in the new “report to Parliament on the management of regional health services”, instead evaluates the relationship between health spending and GDP. The latest Nadef, the update note of the economic and financial document, forecast for 2023 that spending would be worth 6.6% of GDP, then falling to 6.2% this year and next and even to 6. 1% in 2026. All this while in the rest of Europe much more is being invested in healthcare. In 2022 Germany was at 10.9%, France at 10.3, the UK at 9.3 and Spain at 7.3.

Waiting lists and private spending

The public spends less and less and citizens more and more. The healthcare system has not yet managed to restore supply to the pre-Covid period. In 2019, over 210 million visits and tests were carried out, a figure never reached again. In the first six months of last year we did not reach 100 million. With facilities working less and demand tending to increase, waiting lists are getting longer. There are many citizens forced to turn to the private sector to obtain a service in an acceptable time. But there are also those who cannot afford it and wait or give up treatment. The Court of Auditors explains that «in 2022 the expenditure borne by families was 21.4% of the total, equal to a per capita value of 624.7 euros, up by 2.1% compared to 2019». Still making a comparison with other European countries, in France out of pocket is worth 8.9% and in Germany 11%.

Old hospitals

Italy has a problem of old hospitals. Only 18% of care facilities are less than 33 years old, that is, they were built after 1990. Those built before the end of the Second World War are many more, 27%. But recently the government removed from the PNC, the National Plan complementary to the Pnrr, approximately 1.2 billion destined for the “Towards a safe and sustainable hospital” program, inviting the Regions to find the money from another fund, the one for construction hospital. But local administrations dispute procedural problems and above all believe that there is not enough money available in the second fund. Forza Italia has just presented an amendment to the Pnrr decree to cancel the measure.

There are also Pnrr funds to buy new diagnostic equipment and up to now it has mainly been the Central-Northern Regions that have spent them. According to Confindustria medical devices, in Italy there are almost 37 thousand devices no longer in line with the current level of innovation. 92% of conventional mammography machines are more than ten years old, as are 96% of CT scans and 91% of fixed x-ray systems.

The personnel issue

We are in the most critical period for healthcare workers. The period of pension hump for doctors is accompanied by the effects of the restricted number in Medicine. In recent years, the young people who entered when there were few places are graduating. In the future things will improve (for the unions in the end there will also be too many white coats), in the meantime we will suffer. About 10-15 thousand professionals are missing, in particular there are problems in the emergency rooms, in surgeries, in resuscitations. The wages are much lower than those of other European countries, the work is increasingly harder due to the shortages and thus the problem of escapes from the public system, towards foreign countries or towards the private sector, has also arisen. The estimate is that approximately 5,000 out of 100,000 hospital workers left this year. The crisis also affects nurses, who would be even 65 thousand fewer. These professionals also leave and among the problems is the too low pay, 1,600 euros, for those who come to work after three years of university.