Healthcare: it takes a pact between public and private to save it with prevention, ai and data

The health economy is an oxymoron. An apparently improper approach. Healthcare is a primary service. Reducing it to the rules of the market is depressing, but ignoring the issues of its economic sustainability is highly irresponsible. The right to be treated is constitutionally sanctioned, but we often forget that the means to guarantee it are needed. If health is the main common good then it should reduce inequalities and not increase them as it is happening.
A greater civic sensitivity should lead us, as citizens, to demand rigorous management of public resources that are not by their nature infinite. And also to ask us who, in the end, support the National Health Service which cost (in 2023) 136 billion to which 44 of private expenditure are added. 60% of Italians do not pay taxes but everyone rightly have the right to be treated and assisted. The exemptions are sacrosanct; The criminal and non -excuses evasions. Waste in public health and in the consumption of drugs are doubly harmful: taxpayers’ money is disperse and you end up penalizing the most fragile and weak economically.

The role of the private individual and chronic diseases

The private individual has an important role, wrong to deny it. It is right that it has such a return to remunerate capital and ensure investments. But if he enjoys a comfortable profitable niche that repairs him from the competition, choosing the most profitable treatments, he loses his subsidiary function and risks clinging to political power. A relationship, not rarely, dark and incestuous.
We must rejoice to live in a country that has among the highest life expectancy in the world. Also in good health. But those who have higher education live on average four years more than those who have not been able to have it. Regional disparities are intolerable and unjust. With differences, in health expectation in good health, which even arrive at twenty years. Focus on delays in visits and exams, we are underestimating the explosion of chronic diseases and the increase in the audience of non -self -sufficient subjects.
And here an unavoidable question arises, addressed in a study, which we preview, by the Peripato Association and the Anthem Foundation. The public system will not be able to face the future, and inevitable, health and social emergency. It will be necessary to involve the private sphere, especially of the private social sphere, invest in technologies, review the organization in the area, better plan professionalism. A huge social, economic, scientific and managerial challenge. The presence in a family of a disabled person or an elderly man in need of a caregiver is the main cause of impoverishment of a family unit. Chronic diseases affect, directly or indirectly, 40.5% of the Italian population, or 24 million. There are 12 million people from at least two chronic pathologies. 30% of the over 65 coexists with limitations in the basic activity of everyday life (eating, washing, dressing, moving). Public expenditure for non self -sufficiency amounted to 1323 to 13 billion in 2023. That paid by families for long -lasting health care at 4.4 billion. The sum (over 17 billion) is double the cost of the whole Italian University.
In 2030 it is estimated that the non -self -sufficient population will grow by 25% for a total of 5 million subjects. There are about 8.5 million caregiver, mostly familiar. Between carers and domestic collaborators the irregularity rate is 47%. Among the over 800 thousand regular, half is classified as carers. Foreigners prevail, especially from Romania, Ukraine and Moldova. Put these figures in line simply fear. Therefore, they are removed in the public discussion. And it is the most serious aspect. There is also the pathology of removal.

The study was drawn up by a group of specialists (Silvio Brusaferro, Guido Cavaletti, Sergio Dompé, Luca Degani, Daniele Finocchiaro, Giada Lonati, Cristina Mass, Nicola Montano, Fabrizio Oliva, Rosanna Tarricone) coordinated by Sergio Harari and Stefano Paleari. A series of operational proposals has been formulated on how to integrate a new public healthcare model to a more efficient network of structures, not only hospital, in the area. The great drama of the lack of professional figures reported. A vision of the regions too concentrated on political and government autonomy denounced. « Even in Lombardy – we read – there is no possibility of a real integration between social and health services. The answers travel to silos, the needs do not ». Strong investments in health technology proposed. However, « without an adequate organizational and administrative change ».

The fundamental point is to better exploit the data, in particular the national health file, ensuring that there is « a real connection between systems of prevalent hospital nature with the territorial assistance and care component ». Today there are two worlds that are not talking about. « The predictive analysis platforms offer health organizations insights based on the data and trends of the patient’s population ». Great attention is paid to the innovative solutions of Digital Medicine and Digital Therapeutic, or to software « designed to treat or alleviate pathologies ailments and medical conditions through digital interventions with a clinically demonstrated impact on the health of patients ».
Italy, unlike other European and the United States, has not yet regulated and financed these digital therapies. The hint to prevention is strong. Forms of incentive or disincentive (non -punitive) incentive to promote « behaviors that can change the risk profile towards chronic diseases and non self -sufficiency ». And again: « Integrated diagnostic-therapeutic paths could be carried out that starting from the patient’s assistance demand, even detectable at a distance through wearable devices and monitoring tools, they go to redesign the shared management between family doctor and specialists ». This would revolutionize the number of visits and thin out the waiting lists.
« The first thing to do is to take note that, if we do nothing, the current health system is not sustainable, especially from an economic point of view – explains Rosanna Tarricone, professor of health policy at the Bocconi University and among the signatories of the study – The trend is clear and difficult to reversible: the population decreases, the elderly increase, young people emigrate. Chronic pathologies, strongly growing, already represent 80% of health expenditure. At least 50% would be predictable. This means that we must certainly take care of chronic patients better but also and above all prevent the healthy from falling down. A strategic vision is needed: programming, enhancement of human and technological resources, innovation in the organization of services and a more effective balance between public and private. Prevention, by its nature, is a responsibility for public value. The regions have many data but often do not use them or are not put in a position to use them at best. Artificial intelligence could be a powerful tool to build precision prevention using Big Data to stratify the population and create messages, incentives and interventions aimed at satisfying specific needs. This possibility is today strongly limited by regulatory constraints linked above all to privacy. The time has come to courageously tackle this theme with courage. Otherwise we risk dying, paradoxically, for too much privacy ».

And what could the role of the private sector in this scenario be? «Perform a complementary function to the public and contribute to generating a healthy and collaborative competition, based on clear and equal rules for everyone. We need more transparency and equity ».
And the insurance world? « Social insurance coverage, regulated by the State, with income proportionate prizes, can represent a part of the solution – concludes Tarricone – especially in the face of the growing challenge of non -self -sufficiency and long -term assistance. But they must be thought fairly without generating inequalities. A model to follow can be the German one with regulated and accessible prizes ».

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