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Healthcare and social security are the backbones of welfare. The aim of the national healthcare systems is to promote and improve the citizens' health through empowerment, prevention, diagnosis, treatment and rehabilitation initiatives. Health indicators measure a reality that, in addition to being a central item in the state budget, is most of all a primary element of the social assistance. For more than a decade, in Italy and in the European Union, the healthcare system has been subject to reforms aimed at rationalising the resources and containing expenditure.
In 2018, in Italy, among the adult population (18 years old and over) the share of smokers was equal to 19.0%, that of alcohol consumers at risk was 16.4%, while obese persons were 10.7%. The "Gaining Health" program of the European
Region of the World Health Organization supports economic, health and communication interventions aimed at opposing the spread of the main risk factors such as smoking, alcohol, unhealthy food choices and a sedentary lifestyle (the latter is closely related to obesity).
In the European area, public financing of health services is the prevailing choice. In 2016, In Italy, the total expenditure on health (public and private) represented 8.7% of the GDP and 2.1 percentage points of this share were financed with direct households resources.
Between 2001 and 2016, the direct contribution of households to overall health expenditure decreased, while the incidence of overall health expenditure on GDP increased by over one percentage point; this increase was therefore almost entirely financed through an increase in public spending (since 2010 the share of private spending on total spending is growing).
In 2017, Italy's public current expenditure on health amounted to approximately 113 billion euros, equal to 6.5% of GDP and 1,866 euros per inhabitant.
The hospital supply continues to decline over time: the number of hospitals decreased from 1,378 in 2002 to 1,091 in 2016 and to 1,055 in 2017; the inpatient hospital beds were 4.4 per thousand inhabitants in 2002 and 3.1 in 2017. These trends derive from regulatory interventions aimed at reducing and rationalizing health expenditure, promoting the de-hospitalization of less complex cases that are treated by the territorial services.
Inpatient hospitalizations for neoplasms remain substantially stable: from 1,102 hospitalizations per 100,000 residents in 2017 to 1,110 in 2018; instead, the decreasing trend in inpatient hospitalizations for diseases of the circulatory system continues: from 1,856 hospitalizations per 100,000 residents in 2017 to 1,816 in 2018. Also in this case, the reduction in hospitalizations is mainly determined by the non-hospital healthcare services taking charge of patients with health problems that can be managed on an outpatient basis, rather than by changes in the epidemiological situation of the population.
In 2017, in Italy the (standardized) mortality rate for all causes was 86.7 deaths per 10,000 inhabitants, an increase compared to 2016 (84.2 per 10,000 inhabitants).
The mortality rate of diseases of the circulatory system, responsible for most of the deaths, has decreased by about 20% in the last ten years for both men and women, reaching a value of 30.3 deaths per 10,000 inhabitants in 2017. However, this value shows a slight increase compared to 2016 (29.6). The decrease in mortality for neoplasms at a national level continues (25.0 per 10 thousand inhabitants), thanks to the success of primary prevention measures and diagnostic and therapeutic progresses. For both causes, men have higher mortality rates than women, but for neoplasms the gender gap is decreasing over time. The infant mortality rate, an important indicator of the level of development and well-being of a country, which was stable in recent years, was just below three deaths per thousand children born alive in 2017.
In 2018, the phenomena of high risk alcohol consumption and obesity highlighted different territorial situations: in the Centre and North the share of alcohol consumers at risk was higher (18.3%), in the South and in the North-East that of obese persons was higher (11.6% and 11.5% respectively). With regard to smokers, the highest share was found in Lazio (23.4%), Umbria (20.5%), Marche (20.4%), Piemonte (20.2%) and Toscana (20.0%).
In 2016, at a regional level, the levels of expenditure on health per inhabitant were highly variable due to the differences in the socio-economic conditions of households and in the management models of the regional health systems. The per capita expenditure of the geographical areas of the Centre (1899.2 euros), of the North-East (1894.6 euros) and of the North-west (1904.3 euros) were all similar and above the national average (1866.0 euro), while in the South and Islands (1,800.8 euro) the per capita expenditure was lower than the national average.
In 2016, the incidence of the households health expenditure as a percentage of the regional GDP was higher in the South and Islands (2.5%) than in the Centre and North (2.0%).
The average annual private household expenditure on health amounted to just over 1,100 euros in the South and Islands and reached 1,500 euros in the Centre and North. These figures underline a crucial aspect in the expenditure amounts, linked to the income differences of the geographical areas.
In 2018, the attraction index values confirmed that Lombardia (2.8), Emilia-Romagna (2.6), the Autonomous Province of Bolzano/Bozen (2.1) and Toscana (1.8) were the territorial areas in which the hospitals treat many patients residing in other Regions. On the contrary, high outflows compared to incoming ones concerned Sicilia (0.3), Sardegna (0.4), Campania (0.4) and especially Calabria (0.1).
Hospital beds continue to decrease in all Italian regions and the gap between the geographical areas of the country is wide: in 2017 the North-West and the North-East had 3.4 beds per thousand inhabitants, while the South and Islands had 2.8.
Among the Regions of the South, Calabria, with 2.5 beds per thousand inhabitants, had the lowest value ever. Instead, among the Regions of the Centre, Toscana had 2.8 beds per thousand inhabitants and, among those of the North, Friuli-Venezia Giulia had 3.2. The highest values in the three geographical areas were those of Emilia-Romagna (3.7 beds per thousand inhabitants), Valle d'Aosta (3.6), Molise (3.4) and Sardegna (3.0).
In 2017, excluding the differences due to the composition by age of the population, the mortality rate (standardized) for all causes highlighted a disadvantage in the South and Islands. In fact, in the South and in the Islands, a rate of over 93 deaths per 10,000 inhabitants was observed, while in the Central and Northern areas this value varied between 81 and 85. Infant mortality was also higher in the South and Islands and the difference with the Central and Northern areas hasn't decreased over the last ten years.
Although mortality for neoplasms was on average lower in the South and Islands (24.4 deaths per 10,000 inhabitants), the highest rates at a national level were recorded in Campania (36.5).
With regard to smoking, in 2018, Italy, with a percentage of smokers equal to 18.6% of the population (aged 15 or over), was in a central position in the ranking of EU countries; the top positions belonged to Greece (27.3%), Hungary (25.8%) and France (25.4%). Smoking was less common in Sweden (10.4%), Finland (14%) and Luxembourg (14.5%).
With regard to obesity, in 2018 Italy had a percentage of obese persons equal to 10.7% of the population (aged 15 or over); this value placed it among the countries with the lowest values, along with Sweden (13.1%) and the Netherlands (13.4%). Hungary (21.2%), the United Kingdom (20.1%), Finland (20%) and Slovenia (19.2%) had the highest values.
The Italian public current expenditure on health is far lower than that of other European countries. At purchasing power parity, compared to approximately $ 2,495 per inhabitant spent in Italy in 2017, Austria, Belgium, Ireland and Finland exceed $ 3,000, while Germany with $ 4,933 per inhabitant ranks first for per capita expenditure. In 2018, the share of private health expenditure on overall health expenditure (public and private) in Italy was 25.8%, equal to the share observed in Ireland and similar to that of Austria. The country in which the share of private spending was greater was Greece (39.6%); only Portugal and Greece recorded a share of private expenditure of over 30% of total expenditure, while the minor share was recorded in Luxembourg (14.8%), Germany (15.5%) and Denmark (15.6%).
With regard to the supply of hospital beds, in 2017 Italy ranked 24th and it continued to be below the European average (3.1 beds per thousand inhabitants in Italy, compared to the average EU value of 5.0).
In 2017, with regard to hospitalizations for neoplasms and diseases of the circulatory system, Italy continued to occupy a central position in the ranking of EU countries, respectively at the twelfth and eleventh place in the growing ranking of inpatient hospitalizations.
In 2016, the death rates for neoplasms and from diseases of the circulatory system were both below the European average. In 2017, Italy was confirmed as one of the countries with the lowest infant mortality rate (2.7 per thousand children born alive, while the EU average is 3.6 per thousand), a value similar to that of Spain, Portugal and the Czech Republic and slightly higher than that of Sweden.