Health spending eaten up by inflation and 22% borne by households: sustainability challenge calls for sprint on Pnrr, more services and efficiency

22% borne by households

Private expenditure and territorial gaps weaken equity of access and universality of service. In 2024, total healthcare expenditure was 185 billion, 74% of which was borne by the public administration and compulsory insurance, 22% by households, and 3% by voluntary schemes, “with a growth in the share referring to the private component that places the latter among the highest in comparison with the European average”.

According to the Report, ‘significant inequalities persist in the provision of the Essential Levels of Care (LEA) and a clear North-South misalignment. The Regions with a recovery plan (Calabria, Molise, Sicily, Campania, Lazio, Abruzzo, Apulia) continue to show structural difficulties despite some improvements in their accounts. The increase in inter-regional health mobility also marks gaps in the attractiveness and capacity to provide services.

Pillar health under pressure

According to Mef estimates – the Court further notes – healthcare expenditure will grow to 155.6 billion euro in 2028 with an average rate of increase of 3.7% per year. The incidence on GDP will remain stable (6.3%-6.4%), but sustainability depends on the containment of social security spending, which absorbs 68% of welfare spending, and on demographic trends. Spending on social protection (606.7 billion, 27.6% of GDP) shows a qualitative recomposition: emergency interventions are decreasing and structural funds are increasing (mental health, disability, youth). In short, Italian welfare ‘is entering a phase of readjustment, with healthcare still a central pillar but under pressure’. Hence the main challenges of allocative efficiency and spending quality.

Pnrr late

On the investment front, the National Recovery and Resilience Plan (NRP) of Mission 6 Health, in which EUR 15.6 billion are planned to strengthen proximity, digitalisation and health infrastructure, 41% of the objectives were completed at the end of 2024, with the remaining 59% to be completed in the two-year period 2025-2026. The proximity network (with 1,038 Community Homes and 307 Community Hospitals planned) represents the strategic axis for the new National Health Service, but the monitoring showed delays in starting work and difficulties in recruiting staff, with shortages of health and technical profiles that could limit the full operativeness of the new facilities.
While the activated projects indicate ‘good practices of sociomedical integration’, the full operativeness of the proximity network ‘will depend on implementation times and coverage of health and para-health personnel’.

Pharmaceuticals: extra spending ceiling