2.75% of public spending contributes to 18% of Def savings. The Def cuts almost 0.9% of total spending (7.5 billion out of 800) but 2.4% of NHS (2.6 billion out of 110), in proportion almost three times as much. Drugs and devices weigh 2.75% of total public spending (22 billion out of 800) but contribute to the cuts proportionally six and a half times as much, 18% (1.35 out of 7.5). But cutting drugs and devices means penalizing innovation and technology.
The Def of 16.8 billion, of which 6.8 from financial benefits of "exogenous" origin (Draghi, QE, interest on debt, spreads, etc.), provides that of the remaining 10 to be obtained with the reform programme, 2 .5 come from reductions in deductions and tax deductions, therefore more tax revenues, and 7.5 from cuts in public spending (I round off the figures for ease of calculation).
Therefore, the Def cuts 0.9% of public spending, 7.5 billion out of the approximately 800 total. A very small percentage cut.
Però molto orientata sulla sanità: circa un terzo di quei 7,5 miliardi – 2,6 – vengono dal SSN. Pesando la sanità sul totale della spesa pubblica circa un ottavo (110 miliardi su 800, quasi il 14%) contribuisce ai tagli appunto per più di un loro terzo (2,6 miliardi su 7,5), il 35% dei risparmi del Def. Prende il 14% ma dà il 35%.
The Def cuts almost 0.9% of total spending (7.5 billion out of 800) but 2.4% of NHS (2.6 billion out of 110), in proportion almost three times as much.
Of those 2.6 billion, the draft states that over half, 1.35, come from drugs and devices, the expenditure of which in the NHS is approximately 22 billion, 2.75% of total public spending (22 billion out of 800).
Therefore, 2.75% of public spending contributes to 18% of savings in the Def (1.35 billion out of 7.5). It takes the 2.75% but gives the 18%.
– La sanità è quasi il 14% della spesa pubblica totale (110 miliardi su 800) ma ne contribuisce ai tagli nel Def col 35% (2,6 miliardi su 7,5)
– Il Def taglia circa lo 0,9% della spesa pubblica (7,5 miliardi su 800), ma in proporzione quella SSN è tagliata quasi il triplo, il 2,4% (2,6 miliardi su 110) e quella per farmaci e dispositivi oltre il sestuplo, il 6,2% (1,35 miliardi su 22)
– Farmaci e dispositivi pesano il 2,75% della spesa pubblica totale (22 miliardi su 800) ma ne contribuiscono ai tagli nel Def proporzionalmente sei volte e mezzo tanto, il 18% (1,35 su 7,5).
The macroscopic disproportion in the choices of sectors from which to save is evident. Non-linear cuts, certainly desirable in principle, but precisely because they are to be made in sectors where there is actually redundancy and less negative impact.
Certainly not public health, already among the least funded in the EU and with already high criticalities and operating inequities, not on drugs and devices whose spending is already among the lowest in the EU and the OECD. “Stick the drowning dog” wrote Mao.
Naturally there are numerous areas of the most "redundant" public expenditure where it is possible to recover that very modest 1% reduction requested by the Def (already only in the regions those identified above QS from Cesare Fassari).
It can be questioned whether the real reasons for these choices so aimed at health care, on drugs and devices, are strategic, such as the desire to review welfare and remodulate the relationship between public health in favor of private, especially in financing.
Or they are merely tactics, such as offloading the inconvenient burden to the regions, or how to cut drugs and devices because, unlike anything else, it is operationally easier and more immediate (regulated prices and market), less inconvenient and a "disturbance" in the system, less politically unpopular given the unfriendly public opinion towards "Big Pharma" and Co.
What is certain is that cutting drugs and devices means penalizing innovation and technology, the main tools for making healthcare more efficient (less inefficient) and helping its increasingly uncertain future sustainability. In short, it seems short-sighted. De Gasperi said, taking up a quote from Clarke, that the politician thinks of the next elections, the statesman of the next generations.
Prof. Fabrizio Gianfrate
Health economics