Italy’s shrinking markets
It’s more than five years since the Italian government, buckling under a national debt of around 125% of GDP, implemented Mario Monti’s austerity measures, described as one of the severest responses to the financial crisis in Europe at that time.
The public healthcare system, though far cheaper than its peers, was one of the main targets for cuts. In the end, though, much of the strain actually fell on the private operators providing as much as 35% of the hospital care in Lombardy and 25% across the country as a whole.
Law 135/2012 mandated the regions and autonomous provinces to reduce their expenditure on private specialist outpatient care and hospital care by 0.5% in 2012, by 1% in 2013, and by 2% beginning in 2014, relative to the baseline year of 2011. The original formulation of the law would have set the cuts at 1% in 2012, 2% in 2013 and 4% in 2014.
The budget restrictions have still not been lifted. Gabriele Pelissero, president of the Italian association of private hospitals (AIOP), describes it as “a noose that, year after year, strangles the prospect of a pluralistic national health service marked by healthy competition between providers.”
Our sources estimate the for-profit lab, rehab and hospital markets, for example, are losing around 2-3% every year in revenue. That’s the result not just of less work for the NHS but also the damage to the self-pay market caused by the recession.
Italians have always seen healthcare as a marketplace. Even within the public system, they shop around, migrating to neighbouring regions or from south to north looking for the best care.
That freedom to choose has been a vital component of a system that guarantees some of the highest life expectancies in the world for less than half the price of neighbouring Switzerland, for example. Unless the noose is lifted though, it will soon be at risk.
We would welcome your thoughts on this story. Email your views to Claude Risner or call 0207 183 3779.
