The future of health? Tandem between public aid and additional aid

After the state of emergency, the post-Covid phase has brought the elders to the surface criticality of the national health system (NHS), further aggravated by two years of pandemic. To understand this, just look at the number of backlogs (backlogs) in hospital waiting lists: in 2020 alone, more than 1.3 million interventions were ignored, including more than 500,000 urgent ones. A tsunami certified by 2021 report on the coordination of public finances of the Court of Auditorswhich leads to a serious reflection on how to rethink the health of tomorrow and on the new possible areas of intervention in integrative health.

Despite the expected increases in public health spendingwhich fell from 115.7 billion in 2019 to 126 and a little more than 2023-24, and the additional allocations of 15.6 billion euros in Pnrr, only the aging of the population leads to an increase in expenditure that is difficult for the NHS to absorb. “The figures of the Plan, although insufficient, provide for 15 billion euros to develop a new public health structure from a territorial point of view, with an acceleration on telemedicine and digital, but they do not solve the problem public-private integration. what happened during the pandemic crisis,” he notes. Giovanna Gigliottito from UniHi, first health insurance in Italy in number of customers with 11 million patients and one of the most important operators in the management of national and category health funds.

Figures from UniSalute say that, to deal with the pandemic, public health spending in our country has undergone a significant increase (+ 5.3%) from 2020, rising from 115.7 billion euros in 2019 at 123.5 billion euros the year of Covid with an impact on GDP equal to 7.5%. Private spending, on the other hand, suffered a sharp drop, from €40.5 billion in 2019 to €30.8 billion in 2020. “The figure is not surprising for two reasons. The first is linked to the question of the closures imposed during the first confinement, the resulting restrictions on access to services and the caution of users to avoid possible gathering places and possible contagion during the pandemic. The second concerns the fact that beds in private facilities have been used by the NHS to cope with the wave of Covid hospitalizations with the consequent suspension of hospitalizations carried out outside the NHS for carry-over procedures”, explains Gigliotti.

Giovanna Gigliotti, CEO of UniSalute

The hope of an improvement in the situation in 2021 quickly came up against reality, namely theexponential increase in infections due to the fourth wave: “The infections were less serious thanks to the vaccines; however, the Italians still showed some fears and only resorted to the health services in an emergency, for example for a surgical intervention – explains Gigliotti – At the same time time, due to the suspension of routine healthcare services during lockdown, the NHS has fallen significantly behind many services which are still struggling to recover, unlike private facilities which have had an increase in healthcare services provided (examinations, specialized services, prevention, surgery, editor’s note)”.

Why is there no mention of the public health backlog? “In my opinion, this stems from the fact that to carry out a program of this type, the government would have to allocate dedicated resources but at the moment it is in difficulty because the costs have undergone a significant increase to deal with the pandemic” , replies the CEO. What do you suggest? “We are in a phase where we have to plan the future of all our forces on the ground, rethink a public-private integration system that guarantees the sustainability of carein which the public retains its centrality but integrative and therefore private health interventions are expanded: to date, we have approximately 14 million over 65s and approximately 24 million patients with chronic conditions who require structured assistance even at home,” notes Gigliotti.

The other nerve discovered concerns the out-of-pocket health expenses that, unlike other European countries, 89% of Italy is still financed by families and only 11% of the total is negotiated by health insurance, funds and health funds. “The effort of insurance companies must be to offer simple and affordable health coverage. At UniSalute, we recently launched 6 policies that can be purchased online on our site, with which we meet different needs and different targets. : families, athletes, over 65s, students, we also offer a specific product for dental services, which are among the most requested”, specifies the CEO.

Who does hair work is the world of logistics. “In terms of health care, the Sanilog mutual provides services without risk analysis but there are still many workers who do not know it when it is compulsory to register”, warns Fabio Marrocco, co-director of Confetra. This is a problem that the union also points to: “With the new Ccnl for logistics, the contribution paid to Sanilog by companies has risen to €2.50 per month to increase service coverage. Unfortunately, we don’t have no coercive mechanism”. to oblige all companies to sign the contract first, then the fund. However, we were able to bring in both direct workers from Amazon and those from last mile supply chain contracted companies into the fund,” he concludes. Michele De Rosenational secretary Filt Cgil.

Complementary health funds are more successful in the North

I am 322 complementary health funds (Fsi) in Italy for an audience of 13.7 million subscribersaccording to the latest data updated byRegister of health funds. From the point of view of geographical distribution, we observe fairly high concentration in Lombardy, with more than 30% of total Fsi beneficiaries. A much lower concentration is found in some Southern Regions, such as Calabria, Sardinia and Abruzzo, but also in some Central Regions (such as Umbria) and in two Northern Regions (Aosta Valley and Trentino- Alto Adige). Most fund recipients it is therefore concentrated in the Center North Regionswhere the NHS is strongest and where the greatest number of businesses and workers are concentrated and where incomes are higher on average.

UniSalute data shows how 35% of the services provided are directed towards the type of specialist expenditure, 33% towards hospitalizations, 23% towards dentistry, 7% towards prevention and maternity and the remaining 2% towards other blankets.


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