Il sistema sanitario alla ricerca della sostenibilità

The paper analyzes the financial sustainability of Italian health care expenditure within the public finance measures set in 2011. Despite the rest of public administration, health care sector faces better the crises because, since 2005, the imposed central budget discipline has stabilized to zero its real growth. The first part of the paper describes how health savings still continue having a considerable weight on public budget constraint. In the second part, we critically discuss the choice of adding an entry ticket to copayment mechanism on specialistic outpatient services. The simulated economic effects evidence an awaited shifting of medical care demand towards private market. We argument the universal health system could be threatened with a progressive escape of middle class from public health care. We conclude remarking that challenges of financial sustainability should be faced through a greater integration of health and social care services and a stronger convergence policy of regional health care systems as recommended in fiscal federalism reform.