Spending private for social security and health care continues to grow, and with it social inequalities increase: the worrying figure was confirmed during the recent hearings by the Senate Social Affairs Committee of some ISTAT experts.
Cristina Freguja, of the Central Directorate for Social Statistics and Welfare of the Institute of Statistics, points out that private spending is not distributed equally across the board, but weighs mainly on the weakest groups.In this already unbalanced scenario, private insurance is almost exclusively the prerogative of the highest income brackets, which benefit from a private corporate welfare that does not benefit low-income workers.
The many items of expenditure for households
In 2021, total health expenditure – public and private – amounted to about 168 billion euros: three-quarters borne by the public (75.6%), 21.8% borne directly by households and 2.7% supported by voluntary funding schemes, explained Freguja in his report, reporting the most up-to-date data available to date.
Between 2012 and 2021, public health spending grew by an average of 1.8% per year. With the pandemic, it has increased significantly in 2020 and 2021, standing at 121 billion and 127 billion respectively.
Also between 2012 and 2021, spending directly borne by households recorded an average increase of 1.7% per year, reaching 36.5 billion in 2021.
The main items of expenditure for families concern outpatient care for treatment and rehabilitation (36.5%), the purchase of pharmaceutical products and other non-durable medical devices (29.3%), long-term hospital (health) care and the purchase of therapeutic devices and other durable medical devices (for both these last two items the incidence is equal to 10.4%).
As for expenditure on voluntary funding schemes, in 2021 it reached 4.5 billion, of which about 3.4 billion for voluntary health insurance, with an average increase of 2.9% per year.Almost two-thirds of expenditure (62.3%) covers outpatient care for treatment and rehabilitation and 17.9% covers expenditure on therapeutic devices and other durable medical devices.
In 2021, 38% of total spending on long-term hospital healthcare was borne by households. It should also be noted that the latter accounts for 76.7% of the purchase of therapeutic devices and other durable medical devices and for 36.4% of the total expenditure for pharmaceutical products and other non-durable medical devices.
This increase in expenditure for families has unfortunately been accompanied by the renunciation of necessary health services, which has gone from 6.3% in 2019 to 9%, up to 11%, explains Freguja, according to which some estimates indicate a reversal of the trend in 2022, with a return to quotas observed in the years preceding the pandemic, Even if compared to the past there is now an unequivocal barrier to access constituted by long waiting lists.
The private sector competes with the public
When the so-called «Bindi reform» introduced the principles of essential levels of assistance (LEA) for which each Region, even in its autonomy, had to ensure citizens a basket of services considered essential for health, it was already clear that some services would be delegated to cover supplementary forms, to be created shortly thereafter, added Alessandro Solipaca, of the Department of Disability and Social Integration of ISTAT.But this did not happen, and the expected funds were never constituted and, above all, did not operate in the spirit of the law, that is, covering non-essential health services.
And while public health spending has grown slowly over the years, private health has grown more rapidly, with regions burdened by increasingly large deficits that have increased the amount of tickets requested from the citizen-taxpayer, which today in many cases equal the price of the service at a private facility.
This has also led to an increase in private spending, with a well-known dynamic. To counter this, supplementary funds should be revived in order to control private spending. According to Solizzaca, supplementary insurance funds could encourage the emergence of benefits currently paid illegally and combat inappropriate benefits, already among the priorities at the time of the Bindi reform.
«Today private spending does not find intermediation, this does not meet the parameters of seriousness and correctness» commented the president of the commission Francesco Zaffini, of Fratelli d’Italia, who announced his intention to prepare within the next few months a proposal for the reorganization of supplementary forms of social security and health care in the framework of the overall effectiveness of welfare and health protection: «On the one hand, there is the National Health Fund, which today weighs around 127 billion euros, and which is obviously intermediated by the presence of the State in the provision of health services; on the other hand there is a private expenditure that today weighs around 40-45 billion, but someone says even more, which finds intermediation for an irrelevant measure, around 4-5%.This is not possible and does not meet the parameters of other EU countries, but above all it does not meet the parameters of seriousness and correctness. Integrative healthcare must not compete with public health, but at the same time it must guarantee important services, think of dental care».
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Source — https://www.univadis.it/viewarticle/dati-istat-cresce-la-spesa-sanitaria-carico-delle-famiglie-2023a10005qq