Chapter 2

of resource allocation) to underestimate expenditure, so avoiding expansion of expenditure
that may not be appropriate.
On duplication, it should be added that the composition of public expenditure (in the
sense of the ratio between services supplied directly by public provider and those supplied
by private ones) seems to produce a non neutral effect. Specifically, one finds a
positive correlation between total expenditure and the “outsourced” share, though this
phenomenon is limited to the Regions of the Centre-South of Italy. In other words, the
composition of public/private supply is not in itself a discriminating factor, except where
an apparently poor planning configures system inefficiencies.
The econometric analysis provides other information of some interest. For example, it
confirms that the Northern Regions display a basic homogeneity in expenditure behaviour,
whereas the Centre-South constitutes an aggregation of “monads”, with internal
differences yet to be fully explained.
Finally, the model also makes it possible to quantify the effects of redistribution produced
by the solidarity implied by the universal coverage granted by the SSN. The effects
are significant in both size and characteristics. The Northern Regions “renounce” a share
of expenditure that may reach or exceed 15% in favour of the Regions of the South that
may record expenditure 50% higher than would be the case in the absence of solidarity.
This lets one realize the extent to which full attainment of federalism in health care is an
uphill task.
Quantitatively, the model assumes an increase in total expenditure faster than that in
GDP, though for 2007 this phenomena is limited by a significant real growth of the last.
The expenditures should reach a level equal to 8,2%-8,3% of GDP 2 , thus remaining
below the present European average.
The impact on households is limited, since the growth in public resources made available
is counterbalanced by the new (higher) co-payments.
We expect a decrease the burden on household budget of about 6-12%. Nevertheless,
the action aimed at imposing greater responsibility on patients, involves a complex equitative
impact. The adoption of a lump-sum payment on specialist’s prescriptions, lets us
presume an unfair impact on households, especially for those most at risk (see chapter
4.1, Doglia, Spandonaro).
4 The economic scenario: efficiency improvement
The measurement of efficiency (leaving aside merely anecdotal evidence, useful as that may
be) is notoriously difficult, especially in a sector of such complexity as that of health care.
Coherent management of the system also requires keeping apart purely financial actions
and those intended to raise the overall efficiency of the system.
According to Fioravanti and Spandonaro (see chapter 3.1), joining analysis of regional
financial policies (ex-ante) and of their results (ex-post) it emerges that the Regions are
strongly conditioned by the requirement to obtain short term savings.
2 The model uses ISTAT and Ministry of Health data. The level of expenditure cited is approximately consistent with a level
of 8,5%, according to the OECD Health Data standard (see chapter 1.1).
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CEIS Health Report 2006