The Italian health system faces decisive challenges which can be summed up in three key words: ageing, innovation and investment. These challenges are set in an international geoeconomic landscape marked by a progressive decline in population numbers, a rapidly ageing population, and a growing burden of chronic illness.
To address these challenges, the National Health Service (Italian initials SSN) needs to adopt an integrated strategy that includes launching a national advanced diagnostics platform based on artificial intelligence; abandoning the payback mechanism (under which medical device companies are required to contribute to the partial coverage of the SSN deficit); and creating a clearer funding distinction between prevention, diagnosis, treatment, rehabilitation, and palliative care, on the one hand, and interventions related to chronic disability, dependence, and long-term care, on the other. Also needed are targeted funding models for high-unit-cost technologies, a new patient-care model, a review of the value chain, and the creation of an ecosystem based on simplified procedures, targeted incentives, and an expanded research network with the ability to attract investment. Completing the picture are governance reform and stronger public-private partnerships.
The government’s main lines of action start with increasing SSN funding; for 2025 this rose to 143 billion euros, with funds earmarked for recruiting 1,000 doctors and 3,000 nurses, as well as pay rises. Other interventions concern the reduction of waiting times and the implementation of the measures envisaged in the Italian Recovery and Resilience Plan (Italian initials PNRR), specifically technology modernization and upgrades, the strengthening of the local care system, the activation of the digital platform and the introduction of electronic health records. Also under consideration by the executive is a government bill that would place the layers of legislation and rules that have built up over the last quarter century on a more systematic footing.
However, health policies have to comply with public finance constraints that require careful impact assessments for each measure. Action could be taken on rationalizing spending, particularly by rebalancing spending on actual services and transfers to households; the aim here is to rethink the welfare system, especially with regard to care for people with chronic disabilities, high levels of dependency and long-term care needs.
The possibility of testing some of the proposals that have emerged in the public debate should also be discussed. These include financing local health authorities on the basis of diagnostic-treatment-care pathways and reviewing the payback mechanism, including revised spending caps. In this light, the digitalization process and the use of data for research purposes – with the aim of including Italy in the development of the European Health Data Space – are assuming a central role.
A further priority is the preparation of a new Health Plan, the first since 2006-2008, which would focus on prevention and health education. The increase in needs generated by scientific and technological progress can be addressed not only by rationalizing services, but also by encouraging lifestyles that could delay the onset of illness and chronicity. Here, the contribution of the third sector remains decisive. It should be viewed not as a substitute to make up for the shortcomings of the SSN, but as an integral part of the supply system.
The importance of public-private partnerships in the light of value creation along the entire life sciences supply chain should also be reiterated. These partnerships would make it possible, on the one hand, to attract private investment and, on the other, to generate synergies in terms of technological know-how, managerial skills, and the recruitment and retention of professional roles that, in the public sector, are at present difficult to retain.
Another crucial aspect concerns the introduction of measurement systems. While acknowledging that delays have occurred in implementing the provisions establishing quality, structural, technological, and quantitative standards for hospital care in Italy (Ministerial Decree No. 70/2015), this decree has in fact played a part in rationalizing hospital care. Slower progress is being made, however, with the implementation of Ministerial Decree No. 77/2022, which establishes structural and staffing standards – with staff still remaining in short supply and performance and impact standards not yet in place. On this front, the National Agency for Regional Health Services (AGENAS) is engaged in speeding up the collection of information and the dissemination of best practices, in conjunction with the Ministry of Health and the Regions. However, a distinction must be made between data availability and knowledge development, while the purpose of data processing needs to be clarified.
Lastly, the challenges in this sector include the training of doctors, nurses and other health professionals. To improve this sector, economic, organizational and system-level aspects must also be included. The specialist culture tends, in fact, to prioritize the diagnosis and optimal treatment of individual patients, with the overall impact on economic and social sustainability sometimes being neglected.