Chapter 2

CEIS Health Report 2006
The question regarding proper and appropriate levels of health expenditure is a difficult
one to answer. During the past two decades, both Italy and other OECD countries have
implemented a wide range of different and continuously changing models to hold down
costs and improve the financial situation of their health systems. These have included
gradual action in the hospital system, reducing the publicly financed health goods and
services offered to families and increasing the charges to families for dental care (not in
Italy).
This paper reviews the data on health care expenditure in Italy and in thirty 6 other countries
in the OECD area. The emphasis is put on the principal trends in our country, followed
by an analysis of the principal differences between the various countries analysed.
Initially, there is an analysis of health expenditure in relation to GDP, looking at the way in
which the rise in health expenditure and the slowdown in economic growth have contributed
to raising the share of the health sector within the economy. The paper then continues
with an examination of the ways in which health care expenditure is financed in
the various countries considered, and finally with an attempt to investigate how resources
are assigned to the different health goods and services. Conclusions are then drawn.
1.1.2 Health expenditure
Health systems in the 22 OECD countries for which comparison on historical series can
be performed recorded an average expenditure on health amounting to 9,5% of GDP in
2004. In Italy (8,4% in 2004), health expenditure as a proportion of GDP has not altered
much since 1990 (the year from which comparable data are available), also comparing it
with those few countries where changes have been more significant, and has generally
been lower than the OECD mean, confirming a low growth rate (Table 1).
1.1.3 Health expenditure per capita
Concentration only on general data at the macro level may not contribute to better understanding
of the real situation in the countries analysed. Per capita expenditure can therefore
be used as an additional indicator to focus more detailed attention on the distinguishing
trends in the countries analysed and in particular Italy.
Italy, at $ 2.392 Purchasing Power Parity (PPP), is practically in line with the OECD mean
value, though 2004 showed a growth on private per capita expenditure over 2002 and
2003 7 . And it is precisely that trend, regarding private per capita expenditure, that should
start to arouse concern.
The United States also heads the table for health expenditure per capita. In 2004, in fact
it amounted to $ 6.102 (PPP) compared to less than $ 1.000 (PPP) in countries such as
Mexico, Slovakia, Poland and Turkey (Figure 2).
The differences between countries in total per capita health expenditure are in part attri-
6 It should be emphasised that in some calculations it was not possible to include all 30 countries, as there were some for which
data for 2004 were not available.
7 See Colombo and Mennini (CEIS Health Report 2004); Francia and Mennini (CEIS Health Report 2005).
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