24% of the population resident in Italy as of January 1, 2023 (ISTAT data), i.e. 14,181,297 people, of which 9,674,627 in the 65-69 age group (elderly) will benefit from the measures envisaged by the Elderly Decree prepared by the Government. and 4,506,670 over 80 (very old people). “A number which according to demographic projections will increase in the coming years, generating a progressive increase in social and healthcare costs”, underlined Nino Cartabellotta, president of the Gimbe Foundation, who spoke this morning at a hearing at the X Commission on Social Affairs, Health and Public Work and private, social security of the Senate as part of the examination of the Elderly decree. “In fact, according to Istat projections for 2050 – recalls Gimbe – the over 65s will reach 18.8 million (equal to 34.5% of the resident population), approximately 4.6 million more than in 2022”.
“Although formally included in the Lea, social-health, residential, semi-residential, home and territorial assistance services are only partly financed by public health spending. A small part is provided by the Municipalities (in money or in kind), while the majority is supported through cash benefits provided by INPS”, observed Cartabellotta.
In 2022, the most recent year for which all data are available – reports Gimbe – a total of 44,873.6 million euros was allocated to social and healthcare spending, “a total figure on whose precision – highlighted Cartabellotta – various factors weigh factors: different information sources with variable levels of precision and accuracy, possible overlap of amounts coming from different sources”. In detail: long-term healthcare services (Ltc) absorbed healthcare expenditure of 16,897 million euros, of which 12,834 million (76%) financed with public spending, 3,953 million (23.4% ) paid by families and 110 million (0.7%) of intermediated spending (Istat data). INPS has disbursed a total of 25,332.4 million euros, of which 14,500 million in accompanying allowances, 3,900 million in civil disability pensions, 3,300 million in disability pensions and 2,432.4 million in paid leave according to Law 104/92 (source 19th Crea Sanità Report). And again: the Municipalities provided 1,822.2 million euros, of which 1,200 million in cash and 622.2 million in kind (Source 19th Crea Sanità Report). The National Fund for non-self-sufficiency in 2022 was equal to 822 million euros (Source: Research Service – Chamber of Deputies).
“To the almost 45 billion in social and healthcare expenditure – remarked Cartabellotta – are added the funds for non-self-sufficiency provided by the individual Regions. However, there is no survey of these resources carried out by public or private bodies and the resources are not allocated in on a continuous basis as the regional funds are not structural, with the exception of that of the Emilia Romagna Region, which for 2022 amounts to 457 million”.
On regional inequalities in access to social and health services, the president of the Gimbe Foundation pointed out that “the New guarantee system that the Ministry of Health uses to monitor the Regions' compliance with the LEAs has three 'core' indicators on the measures contained in the decree”. Indicators on which regional performances document enormous inequalities, notes Gimbe. Compared to a national average of 40.2 people per 1,000 inhabitants, there are notable differences between Regions: from 144.6 people per 1,000 inhabitants in the autonomous Province of Trento to 4.1 in Campania. In general, all the Southern Regions are at the bottom of the table and no Region exceeds 20 assisted per 1,000 inhabitants. “Obviously – commented Cartabellotta – this figure is influenced downwards by the availability of other forms of assistance for non-self-sufficient people, in particular integrated home care”.
Separate chapter for palliative care. The indicator defines the ratio between the number of cancer deaths assisted by the palliative care network and the total number of cancer deaths. Compared to a national average of 28.4%, the regional variability varies from 56.2% in Veneto to 4.5% in Calabria, recalls Gimbe. “On this indicator – Cartabellotta pointed out – it should be noted that, according to the parameters defined by the ministry, only 5 Regions are compliant: Emilia Romagna, Liguria, Lombardy, Tuscany and Veneto”.
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