Abstract Chapter 3

Chapter 3 illustrates data on the financing, health expenditure and operating results of the Italian National Health System (INHS), integrating them with an international comparison and with regional insights. Evidence shows that, on the international scene, Italy has a limited health expenditure with a public coverage of 74.5%, in line with other European countries but in slight decline. At the national level, the current healthcare expenditure paid by the INHS has stabilized in the last 8 years, with an average growth rate of 0.8% since 2010. In 2017, it increased by 1.3% compared to 2016, amounting to around 117.5 billion euros. As in 2016, in 2017 a global accounting deficit of 282 million euros was registered (0.2% of current public health expenditure). The increase of the total healthcare expenditure compared to the previous year was due to the growth in purchases of goods and services (+ 3.8%), in contractual specialty care (+ 2.0%) and in other contractual assistance (+1.1%). However, overall stability is accompanied by significant heterogeneity at regional level, especially in relation to the variability of expenditure and the impact of the latter on regional GDP. Nevertheless, the regional variability of the per capita public health expenditure is slightly decreasing, indicating that the cost of care is slowly homogenizing. This trend is even more visible if mobility is taken into account, bearing witness to how the real demand for services is not very variable between regions. In contrast, the variability of the incidence of public health spending on regional GDP is increasing. This evidence highlights the contrast between a system that tends to standardize cost functions and, on the other side, finances itself by local economic systems that are increasingly different from each other. This is a dynamic to be kept into consideration in order to maintain the INHS's unity not only in terms of costs but also in terms of finding the resources that contribute to its funding.