Abstract Chapter 3

Chapter 3 aims to position the INHS within an international context (EU, North America and BRIC countries). The analysis provides an overview of the main indicators for health financing, supply structure and performance.

Emerging evidence suggests several points to emphasize:

• Total health expenditure per capita and the level of public coverage are lower than similar measures for the main EU countries (with the exception of Spain). The European context is generally characterized by parsimony, which negatively affects public coverage. This negative effect is due to the lack of perfect substitutability between public and private expenditure.

• In 2015, the share of self-reported unmet needs slightly increased in Italy (7.9% of respondents – Eurostat data). Healthcare renunciation is increasingly due to the cost of services (in particular for the lowest income citizens).

• The number of hospital beds decreased in all countries. We observed a strong heterogeneity in terms of distribution between acute and long-term care beds. Hospital discharges per 100,000 inhabitants have decreased in the last ten years, reaching a value below the EU average. However, the length of stay is aligned with the main European countries.

• With regard to inappropriate hospitalization (asthma, COPD and diabetes), Italy has the lowest rate among the countries analyzed. We also observed a large reduction in the number of caesarean births (although it is still one of the highest rates compared to the other countries) and high consumption of antibiotics.