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. Healthcare and pensions absorb all those resources that could be made available for other social policies. In the future – considering the progressive aging of the Italian people – this tendency will only worsen. Therefore, the first 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.
How can we manage to create a similar balance? The question hinges on two fundamental and complementary factors: on one hand, the system’s complex financial holdings; on the other, the quality of Italian healthcare (which has been high enough to put Italy at the top of the World Health Organization’s list for the last few years).
The first factor, clearly of a financial nature, is tied to the ongoing federalist transformation of Italy’s institutional system (which began with the Title V reform of the Constitution, and which is currently under discussion with regards to fiscal federalism). On this front, the federal state perspective and the wide efficiency gaps between the country’s various regions require a reorganization of the healthcare system’s financial mechanisms. Essential elements like the demand trends of healthcare services, the impact on public expenditures and the possible contribution of funds and securities need to be reviewed. Furthermore, the healthcare system’s management models need to be revamped in order to promote operator responsibility and quality services.
The second factor deals with the evolution of healthcare services from a medical and specialist point of view. From this viewpoint, 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.
Along with these considerations, Italians’ health conditions and quality of life were examined in a further session designed to broaden the focus of discussion. In this area, there is substantial agreement on maintaining prevention as the central element of the most modern diagnostic techniques: it contributes significantly to safeguarding public health and to the betterment of conditions. In a global rethinking of healthcare, the planning and financing of an organic strategy for prevention becomes central in maintaining the health and well-being of citizens. Feasibility, effectiveness and economic efficiency must all be evaluated in an effort to extend active lives, with practical results in work productivity and the sustainability of the welfare system.