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

The last year has witnessed many relevant changes in the Italian Welfare State. In the field of pensions the second half of 2011 has been characterized by an intense debate (par. 2.2.2) on austerity measures “imposed” by exogenous pressures mostly stemming from the interplay of financial market crisis and EU rules on public finance in light of the high Italian public debt, a public deficit persistently above the 3% threshold and continuous slow growth of the domestic economy since a decade. Limited cost containment interventions on the public pension pillar were included already in the austerity packaged adopted by the Berlusconi government in early-summer 2011. Later they were much reinforced with the adoption of the so called “Save Italy Decree” in December 2011 by the technocratic Monti government (par. 2.2.1) following an unprecedented intervention of the European Central Bank in the domestic policy-making (par. 2.2.3). Legislated measures have aimed at reducing pension expenditure in the short-medium term (par. 2.2.4), by accelerating the phasing-in of the NDC system introduced in 1995 and tightening eligibility conditions for both old age pensions and early retirement. Accordingly, a further reduction of public pension expenditure (still high in 2010, around 15.3% on GDP) is expected in the period 2012-2027. While positive for financial and economic sustainability, subsequent retrenchment interventions may pose adequacy – as well as equity - problems in the short and especially in the long run, especially considering the design of the Italian pension system (based on NDC plus DC pensions), the limited development of supplementary pillars in the last four years and interactions with the labour market structure and employment policies (see discussion, par. 2.2.5). In comparison to the previous year Report, since 2011 there have been relevant changes in the Italian health care system (NHS), not with regard to coverage and benefit package, but in terms of co-payments, public expenditure and competition (in the drugs distribution area), especially looking at the decisions which will affect the NHS in the near future (par. 2.3.1). Looking at reforms carried out between January 2011 and mid-February 2012, one can notice they mainly (and almost) only focus on the issue of the financing of the NHS, especially reducing expenditure. Three main interventions can be noticed: improvement in NHS expenditure efficiency; expenditure cuts; increased competition in the drugs and pharmaceutical distribution market. In terms of political debate and health care the main issue, apart from financing, on which the dabate has focused in the last months is about the role of health professions in the NHS (par. 2.3.2). In particular during these months the Parliament is discussing a law on “clinical governance” (the first articles of this potential new laws have been approved by the Parliament Committee on Social Affairs), which tries to reshape the way decisions are made at the local level. The debate on the OMC in the field of health care has not had any relevant apparent impact (par. 2.3.3). As in pensions, the EU was relevant in terms of rules on public finance in light of the high Italian public debt. Three main problems seem to put the formal universal coverage by the NHS at risk (par. 2.3.4 and 2.3.5): territorial inequalities; income inequalities in the access to services; the functioning of integrated social care and health care and the more general issue of LTC. The recent reforms and financial (planned) cuts risk to make them even more dramatic in the near future. In comparison with pensions and health care, legislative production in 2011 was almost absent and mainly related to financial cuts: the recent budget planning laws have deliberated quite relevant expenditure cuts. In particular the state financing of social care and social assistance was totally cut between 2008 to 2012 by 91% (from 2.5 billion € 0.2 in 2008 billion in 2012) (Ires, 2012). Inside this cut, there is also the one to the National Fund for Dependent people (Fondo Nazionale per la non autosufficienza), introduced in 2007, whose total amount was equal to 400 million € in 2008 and has been reduced to 0 € for 2012. Moreover there is the possibility of major cuts in social care and social assistance, also in relation to LTC: these cuts, if they will happen, might jeopardize the functioning of a good part of LTC system in the future.