Sostenibilità del Servizio sanitario nazionale e fondi sanitari integrativi: un contributo al dibattito

The present work aims to offer a useful reference framework to analyse the functioning mechanism of the National health service (Nhs) and to understand if its financial sustainability could be better guaranteed through the consolidation of a multi-pillar model in which non-profit supplementary health insurance (second pillar) complements the public basic coverage (first pillar). The prospect of a contraction in the share of Gdp allocated by Italy to public health expenditure (also due to the persistence of binding financial constraints) together with the evidence of a private spending largely financed through out-of-pocket payments and essentially without intermediation have led many analysts and politicians to propose an expansion of the role of supplementary health insurance. The phenomenon of supplementary health insurance appears today very complex and articulated and requires a complete reorganization of the legislative and fiscal framework. Supplementary health insurance can effectively represent the second pillar of the Italian health care system – without compromising the values of universal coverage, solidarity in financing and equity in access on which the Nhs is based – only if it will be governed effectively, correcting the current distortions and enhancing its potential in terms of social well-being.