Pensions, Health Care and Long-term Care in Italy, Asisp Annual National Report

In the period covered by this report (January 2010 – May 2011) developments have been rather different in the three social policy sectors of pensions, health care and long term care. In the field of pensions, recent reforms of the public pillar have mostly dealt with eligibility conditions for both old-age and seniority benfits. In particular, the link of both age and contribution requiremements with changes in life expectancy has represented a major step forward in aligning the Italian pension rules with recommendations by the EU. In spite of the relavant changes recently legislated, the pension debate in Italy has not been particularly intense in 2010 and the early-2011 and policy proposals have pointed at (more or less) limited adjustments to the existing pension architecture. This is the consequence of various factors, among which i) the important reforms already adopted in the 1990s-2000s, in combination with, ii) the widespread consensus among politico-institutional and social actors on the need to continue on the path of fiscal consolidation, and iii) the fact that the 2008-9 financial crisis did not have a disruptive impact on supplementary funded schemes which are still in their infancy. Especially concerns regarding the sustainability dimension of the public pension system have been very limited; by contrast, several contributions have stressed the risk of inadequate old age protection in future decades as a result of the interplay between the “dual” labour market and the emerging multipillar pension system based on NDC plus DC schemes. In a comparative international perspective the Italian NHS seems to function relatively well and the reforms undertaken in the last years do seem to improve this functioning. The different bills and agreements passed since 2010 try to focus on different aspects of the NHS (from specific relevant issues, such as palliative care, to more general ones, as prevention or Oncological care). Overall the system seems to be improving, but there are very serious problems that can blur this general picture: social inequalities between individuals and households with different income levels in the access to healthcare; territorial inequalities in the access to decent healthcare (the North-South divide); from this point of view it is not clear what the impact will be of a broader regionalisation of the NHS thanks to federalism; a still too weak system of integrated social care and healthcare for chronic diseases (see on this issue the following paragraph); a forthcoming shortage of medical professionals. Apart from more strictly health challenges (how to cure cancer better, cardio-vascular diseases, etc.), the four issues just quoted represent the main worries for the future of the Italian NHS: the developments from 2010 have not shown many improvements in this respect. In comparison to healthcare, there was not too much policy innovation in the LTC field. Also the Italian public LTC seems to show to different “sides”: one positive, the other one more problematic. One side, the positive one, is represented by the fact that today more than 10% of the elderly do receive some form of public coverage for their LTC problems. This level of coverage is not distant or different from the ones typical of many other Western EU countries. The more problematic side is related to the fact that this coverage comes mainly from cash programs and less from the delivery of services. The fact that the system is cash-based (and it is increasingly so) has three effects, strongly linked with each other: still a lot of pressure and responsibilities are on family carers’ shoulders; a private care market (quite often “grey” and made by migrant women) has developed tremendously in the last 10-15 years; the investment in professional human resources in the public sector for facing LTC needs has been limited. Moreover, as for healthcare, there is a clear (and worrying) territorial divide with the Southern regions showing a very limited level of LTC service provision in comparison with the Central-Northern ones.