2023 OASI Report: what choices for a sustainable National Health Service?

The annual presentation of the 2023 OASI Report – the Observatory on Companies and the Italian Healthcare System by SDA Bocconi – served as a platform for discussing the present and future of the National Health Service (NHS). The event saw the participation of various guests, including Americo Cicchetti from the Ministry of Health, Luca Baldino and Elisa Sangiorgi from Emilia Romagna Region, Ettore Cinque from Campania Region, Monica Calamai from AUSL Ferrara and Carlo Nicora from the Irccs Institute of Cancer in Milan.

The event, held on November 28 and made possible with the unconditional support of Viatris and Roche, shed light on the context of austerity in healthcare spending, juxtaposed with significant investment opportunities through the funds of the National Recovery and Resilience Plan (PNRR). The provision of the National Healthcare Service is already implicitly rationed, and in the coming years, demographic changes are expected to worsen the situation. Despite extraordinary funding during the Covid emergency and an increase in the hiring of medical personnel, current healthcare spending has returned to decline in terms of its share of national wealth: according to estimates, it will decrease from 6.7% of GDP in 2022 to 6.1% in 2026.

"With limited resources at its disposal, the National Health Service (NHS) must take on the responsibility for one of the world's oldest populations," states Francesco Longo, scientific director of the OASI Report, curated by researchers from the Center for Research on Health and Social Management (CERGAS) at SDA Bocconi. "Twenty-four percent of Italians are over 65; 40% report at least one chronic condition, and 21% have multiple chronic conditions. Nearly 4 million people are estimated to be non-self-sufficient, with a reduced coverage rate for their needs. Currently, half of specialist visits and one-third of examinations are borne by citizens."

The strategy suggested by the report to mitigate the structural gap between the demand for healthcare services and the availability of resources to provide them is to shift the focus to demand management, moving from the logic of services to that of comprehensive care and prioritizing access to specific services. To achieve this, a detailed analysis of the consumption patterns of patients with homogeneous health profiles is necessary to identify areas of over- and under-treatment, taking into account activities in the private sector as well; this includes limiting prescriptions to what can be effectively delivered, streamlining procedures by aligning prescription and booking moments. It is a challenging but essential path for the sustainability of the system.

According to Alberto Ricci, coordinator of the OASI Report, "we are facing a declared universalism that, in reality, is selective. This raises the question, to be evaluated at the level of each service, of whether to define conscious priorities, aimed at identifying the most intense needs and responding to them effectively, or to continue accepting rationing dictated, most often, by chance or individual ability to navigate the bureaucratic system."

The Report emphasizes the importance of not only technological but also organizational innovation, with a focus on the role of healthcare companies and top management strategic directions. It proposes a multiprofessional and multidisciplinary approach, concentrated on prevention and interventions related to chronic conditions. Such a reorganization of the National Health Service, transitioning from a performance-oriented to a comprehensive care-oriented approach, would ultimately be a way to make the funds from the National Recovery and Resilience Plan (PNRR) truly impactful compared to simply enhancing services with an unchanged model.

SDA Bocconi School of Management

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