The Italian health system: sustainability, quality and responsibility
Demographic waves, technological innovation and citizens’ expectations: these are today’s major challenges. And, in the years to come, healthcare will become an increasingly important issue in all major countries with advanced economies and welfare systems. In the Italian system, the healthcare challenge is particularly crucial as it represents the largest public expenditure after pensions. The knot that needs to be loosened is that of the sustainability of the Italian welfare system. In justifying the elevated costs – which cannot be avoided as they are tied to the universal nature of healthcare in the European social state model – access to services and the quality of services delivered must be guaranteed. Reforming the Italian healthcare system also means intervening in the complex measures that allow the system to assimilate scientific and technological innovation and diagnostic/therapeutic progress. Such progress opens the way for new sorts of hospitals, which can delegate diagnostic practices to generalist facilities spread throughout the territory and therapeutic practices to more highly specialized facilities.
Fiscal federalism: the measures needed for modernization and efficiency in Italy
The participants at this conference observed that fiscal federalism in Italy represents an opportunity not to be missed if the country is to embark on a new and more modern approach to public administration and policies which brings citizens into closer contact with the authorities responsible for making revenue and expenditure decisions. The recovery of efficiency margins must constitute a priority goal of fiscal federalism, which should aim to eliminate any form of duplication in the performance of functions. Rather, there should be an emphasis on freeing up resources that could be progressively ploughed back into the private sector by reducing tax burdens. For the purposes of ensuring the complete success of the reform, it must represent the outcome of a wide debate, to be conducted within a parliamentary forum, involving representatives from sub-national levels of government and from both sides of the political fence. This process should start with a survey of revenue and expenditure flows at the central and sub-national levels, which all relevant responsible institutions should assist with. Finally, of pivotal importance (in terms of measures aimed at ensuring effective political management of the transition process leading up to the definitive introduction of fiscal federalism) was the suggestion that Italy should pass from a system of co-equal bicameralism, as envisaged by the Constitution, to an unequal bicameralism model, thereby guaranteeing adequate representation for local autonomies.
Global economies and Italian businesses: high technology, creativity and design as the keys to success
The conference discussion focused on the fact that the global economic scene is suffering from a worldwide slowdown in growth, the effects of the recent American financial crisis, monetary imbalances between the US dollar and the euro and rising inflation due to an increase across the board in the price of raw materials (and not just energy resources). The growing complexity of global economic, financial and monetary scenarios has compelled Italian business and the Italian economic system to adopt a different approach to increasing competitiveness and growth. The sectoral specialization model is still based on so-called “cash-cow” products, but businesses have innovated in their processes, products, organization and markets. The quality-price mix has changed, with a renewed emphasis on brands, reliability, design and the combination of form and functionality. Several adaptable multinationals have also established themselves as leaders in global niche markets. Even this is an innovation, underlining the strength of the “fourth capitalism” made up of Italian businesses that have 500 million to 3 billion euro in turnover. Nevertheless, it was felt that there is no call yet for over-optimism, given that the international competition is hard on Italy’s heels.
Organizational models and new incentives for research in Italy
The future and competitiveness of Italy depend on research development and on the productivity of the university sphere. The conference debate centered on the rules and mechanisms required to innovate and strengthen Italy’s research sector, exploring, in particular, ways of financing research and mechanisms for ensuring transparency and meritocracy. Another hotly-debated issue was the need to make the most of human capital and to rejuvenate the research sector, moving from a brain drain to a brain gain, by overcoming the overabundance of administrative and legal hurdles and attracting qualified human capital from abroad into universities and research centers. Thus, greater investment is needed. However, more importantly, new rules and organizational models are required that guarantee a leadership role in Europe for Italy in areas in which the country has already demonstrated excellence, and that also enable Italy to face the challenges posed by the United States, China and India. Discussion focused on the link between research, the national interest and local area development, analyzing the mechanisms required in order to bring about territorial groupings capable of generating research and innovation.
Politics and anti-politics
The conference highlighted several historical problems which afflict the relationship between Italians and their political leaders. Italians widely view their politicians as lacking moral rectitude, costing too much and being inefficient. The unpopularity of the political sphere today can be principally explained by the fact that it is perceived as using up public resources and not providing a service to citizens. In order to renew Italy’s political class, the current perverse method of selection based on party loyalty and devotion to a political leader must first be abolished. Selection must then be based on merit, skills and professional experience. A shared culture of rules that need to be followed also needs to be instilled. Only in this way will it be possible to once again revive constructive dialogue on important issues that truly reflects the diversity of approaches to society and development. The analysis conducted during the conference was further enriched by a comparison between various international models, with mention being made of Angela Merkel in Germany, the US primaries and political model as well as the phenomenal success of Sarkozy in France.
Moving from “Made in Italy” to “Made best in Italy”
The conference participants noted that the Made in Italy label represents a tradition of excellence which needs to be relaunched on the international market as soon as possible by breathing new life into support mechanisms for Italian export companies. Closer attention also needs to be paid to the important debate currently in progress regarding international trade rules and strategies to protect and promote production. Europe, in turn, was called on to revisit its trade policy from a new perspective, to adopt a more aggressive and more effective approach. The participants highlighted that, although businesses operating in the field of the so-called three “Fs” (food, fashion and furniture) are particularly privileged in Italy, outside the country the existence of other areas of excellence is recognized – areas which need to be acknowledged and rewarded. Indeed, thanks to strong brand investment, a focus on strategic and budgetary targets and attention to the traditional strengths of Italian production (namely creativity, design and aesthetics), many companies have carved out a significant and recognized niche in the global market. The conference participants also pointed to the importance of local area identity and the role of finance in the growth of Italian companies.
Convergence Italian style: how is the telecommunications market changing?
Innovation has been at the heart of all progress and industrial development in Italy. This was the premise that underpinned the analyses and proposals – which emerged during the conference – for a greater rationalization of the framework of European and Italian innovation mechanisms and for further expansion of cooperation initiatives in this field. The participants also discussed Next Generation Networks (NGNs) which, it was observed, are true information highways that are platform-neutral and characterized by a high-information flow capacity, thus making services possible that are independent of the type of network and technology in use. In order to take advantage of the opportunity that NGNs provide to increase Italy’s competitiveness, substantial public and private investment is required and important political and legislative choices need to be made. In particular, Italy will have to build new infrastructure and split existing networks. Old and new operators alike, working in conditions of strong competition and within a clear legal framework, will be called on to respond appropriately to market demand with content and services that are highly interactive and conducive to the formulation of models for consumption, social dynamics, entertainment and information-sharing, as well as business operational models.
Social integration, security and immigration: the challenges for Italy
One issue that is core to Italy’s economic and political future is immigration. The local administrators, political leaders belonging to various parties, leading religious and academic figures, as well as representatives from the Italian trade-union movement and business sphere who participated in the event underlined that immigration is fundamental for the development of the country. The integration process must therefore involve the assimilation of different cultures whilst respecting diversity. Several participants expressed a hope that the European model would be followed, based on civic education and dialogue between diverse communities, without overlooking the need to guarantee individual rights. The proposals put forward during the discussion included: assisted voluntary repatriation, greater Europe-wide cooperation between police forces and efforts to overcome mistrust between countries in order to pool together their individual database resources.