Sanità pubblica in declino tra necessità di riorganizzazione e risorse limitate

Italy’s challenges of NHS reorganisation are set within a context of resource planning that includes the end of PNRR’s extraordinary allocations, the restart of the Stability and Growth Pact and the return to a discipline-based budget policy. Health expenditure will grow, but at a slower rate than GDP, with potential risks for the NHS sustainability. Staff recruitment has not been planned any longer by the last budget law, while flexibility has been encouraged and the working age prolonged. Private «intramoenia» activity by NHS staff has been incentivised with increased hourly rates and the relative earnings taxed under flat taxation, also extended to nurses’ overtime. Due to a change of priorities, the focus of health policies has been shifted to the management of long waiting lists, which lack a unified information system. Growing shares of public health expenditure have been reallocated towards private providers. The strengthening of integrated health home care, with the goal of covering 10 per cent of the over-65s, led to the concentration of extraordinary funds on low complexity health home care, as the long-term care reform, currently being implemented, suffers from insufficient funding. There remains an urgent need for a better resources’ allocation and to define national tariffs based on risk stratification, in order to ensure comprehensive and continuous home care over time for patients who require it.