As an opening premise, the participants at this National Conference noted that any reflection on the future of the Italian national health service must first start with an analysis of the value produced for the country in health terms. In this regard, statistics were cited indicating that between 1951 and the present day, life expectancy in Italy has increased by 1 month every 4 months. Italy also has the longest-lived population in Europe, with over-65s already making up 20% of the population, or 12 million people, of whom 3.5 million are over 80 years old (6%). Moreover, by 2050, the number of over-65s will increase by 8.6 million, more than half of which (4.7 million) will be due to a rise in the number of people over 80, the percentage of whom over the total population is expected to more than double.
This, it was observed, is a result that Italy has achieved and is able to maintain at a lower cost than that incurred in other European countries, both in per-capita terms and as a percentage of GDP. In light of this, it was viewed as essential, first and foremost, to recognize the importance of the national health service and to acknowledge that it represents a real asset to the country, one which is based on universal access, critical mass, value for money, and the commitment and professionalism of all those involved.
The increase in demand for healthcare stemming from an aging population (with over-65s requiring double the care of the average population) and access to new technologies (which are often more effective but also more expensive due to the vast investment needed to ensure their availability) was seen as calling for an injection of greater resources into the health system, which today represents one of the more significant draws on public finances.
Another consideration that it was felt also needs to be taken into account is the fact that life sciences in Italy represent not only a major area of demand, but also one of the most advanced sectors of the economy in terms of its intensity of research and development activity, its high level of value-added, and its competitiveness in export markets. It constitutes a strategic sector for the revival of Italian economic growth – a necessary precondition in order for the country to have adequate resources to allocate towards health.
For this reason, the issue of the management of the national health service and the ability to guarantee access to the most innovative treatments needs to be considered from various angles (including from a scientific, economic, and political standpoint), especially as regards the formulation of a sustainable development strategy that simultaneously meets healthcare demand, contributes to keeping public finances in balance, and ensures a capacity for growth.
Faced with the demographic trends cited earlier in the discussions, it was suggested that, in order to maintain standards of care and universal access to the national health system, all stakeholders involved need to assume greater responsibility for the appropriate use of resources. This is especially the case in respect of:
- doctors, patients and their intermediaries (including families, interest and advocacy groups, the voluntary sector and so on), for whom concepts such as appropriateness, prevention, immunization, screening, compliance, persistence with therapy, patient cost-sharing, and healthy lifestyles will become increasingly important;
- national and regional authorities, so as to introduce elements of governance that ensure uniform standards of service throughout Italy and the spread of best practices, thereby reducing the large disparities currently found between different areas of the country; and
- the business and scientific spheres, which were called on to step up their research efforts and ensure an appropriate economic, scientific and social return on funds received.
In conclusion, the participants were at pains to stress that this intergenerational responsibility concerns both the present, in terms of providing adequate responses to care needs – primarily for the elderly, as well as the future, in terms of guaranteeing – for younger and future generations – the sustainability of the system and the capacity for economic growth in sectors at the cutting edge of the knowledge economy.