Three decades of EU fiscal austerity have left the Italian National Health System unprepared to face the Covid epidemic. This is what emerges from an article by three economists published in the German magazine Intereconomics in the May / June issue which closely examines the connection between the drop in public spending on healthcare in Italy and the budget squeeze adopted by the various governments in office in order to comply with the tax precepts established by the Treaty of Maastricht onwards. The paper – published by the Leibniz Information Center for Economics (Zbw, the world’s largest research infrastructure for economic literature) and the Center for European Policy Studies (Ceps) – is signed by two researchers from the Berlin School of Economics and Law, Alessandro Bramucci and Franz Prante, and by Achim Truger, professor at the University of Duisburg-Essen and member of the Council of the five essays who supports Angela Merkel’s federal government in economic policy decisions.
Tracing the trend of public health expenditure from the early 90s until recent times, what emerges is a pitiless account of cuts in beds, infrastructure and health personnel. The “cost containment” was immediately motivated by the macroeconomic context “characterized by Italy’s efforts to meet the Maastricht criteria and the requirements of the Stability and Growth Pact which led to an overall tightening of public spending”. The same trend towards containment was seen on the occasion of the 2008 financial crisis which, in concert with the political response to the euro crisis, put the economy to the test “by making restrictions on spending on health “.
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Italy, scholars recall, has recorded primary surpluses for almost thirty years, that is, the state spends less than it collects, integrating a fiscal discipline that not even the so-called “frugal” countries can boast for a similar and so prolonged period of time. If public debt has never been able to drop, it is mainly due to the impact of interest expenditure. This almost spasmodic attention to reducing public spending to obtain savings and reduce debt, the result of EU rules or at least of their application, had a direct impact on the health services offered by the State, showing all the shortcomings in the most dramatic period of the Covid crisis . “European treaties – explains Alessandro Bramucci, one of the authors of the article – at HuffPost – impose policies of fiscal consolidation and return of public debt within the pre-established parameters. In Italy and in other southern European countries this has translated into cuts in public spending in sectors of fundamental importance for the population such as health “.
The data shows that periods of strong fiscal consolidation correspond to periods of restrictions on spending on public health. “If you look for example at the evolution of public health expenditure per capita at constant prices (OECD data), you can see how this was subject to strong restrictive policies in the early nineties when the country committed itself to respecting the Maastricht parameters for join the monetary union. More recently, following the austerity policies that followed the 2011 public debt crisis, there has been an even more marked reduction in healthcare spending, “continues Bramucci.
As reported by the article of the three economists, neIn the period from 2010 to 2018, real health expenditure per capita decreased by 8.2 percent while in France it increased by 17 percent and by 18 percent in Germany. “The aggregate data confirm this difference,” explains Bramucci. “While from 2008 to 2018 in France, total public health expenditure (which includes investment, personnel expenditure, research and development etc.) increased in nominal terms (ie including inflation) by 26 percent, and in Germany by 44 percent, in Italy it increased only by 5.33 percent (Eurostat COFOG data) “.
As for the number of beds for intensive care, there is also a decline here. The study reads that “in 1990 Italy had seven beds per thousand inhabitants, a value close to Germany and above the EU average. In 2017, the number of intensive care places fell to 2.6 ″, while in Germany it remained at six beds.
At the conclusion of the scientific contribution of the three economists, there is no need to comment: “The Italian population is paying the price for prolonged restrictive budget policies in the National Health Service. The unilateral focus on tax constraints and debt relief has deprived the Italian health sector of an important part of its ability to offer adequate protection to people. The outbreak of the health crisis has rung an alarm bell that cannot go unheeded ”.
On the other hand, it cannot be excluded that, in the event of a new emergency, healthcare will go into crisis again as happened in March and April last in Northern Italy: “To avoid such a situation, one could think of the introduction of a rule golden ratio of public investment in European treaties, or a spin-off of public investment from the calculation of the deficit “, adds Bramucci, who remembers how” for several years there have been proposals in this regard. But to do this, however, a strong political will at European level is needed. “
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