The Health & Hospitals Report/2018 describes the performance of the Italian hospital system, which is an extremely large organization, numbering more than 1,000 health care institutions, 200,000 patient beds, 8.8 million hospitalizations, 632,000 employees and a total expenditure of EUR 63.1 billion, equal to 55.4% of total public health care spending.
The perspective of the Report has always been characterized by a dual examination, one addressing the users and citizens for whom public health care and social protection was conceived and, one addressing the "machine", in its various components, which exists beneath the banner of a mixed public-private system as envisaged by law and also in the way it is perceived and used by citizens.
This year, on the demand side, attention was focused on two particularly "hot" issues concerning waiting lists, on the one hand, and access to emergency services, on the other. These two experiences involve a significant (and sometimes multiple) flow of people, and affect 38.7% of the adult population for the former and 28.7% for the latter. Problems of "congestion" can thus become manifest causing anxieties, tensions, dissatisfactions and - sometimes inappropriate - alternative behaviors in the use of the Emergency Room, in addition to increasing the out-of-pocket expenses for families. In order to better understand the two areas mentioned, three parallel surveys were conducted on the adult population, on people who have actually experienced waiting lists and Emergency Room services during the last twelve months, and finally, on caregivers.
Parallel to this, on the supply side, an analysis of the "machine" was prepared that measured its average performance levels despite everything, as attested to by the trend of the indicators of the services provided and - for the first time - also by the indicators relating to the outcomes of care as well as the perception of the quality of services by citizens and users. All of this was effected through the annual monitoring of the efficiency of public Hospital Centers by way of examining and making a (multi-year) comparison of the consistency of the items on the Income Statements.
At present we are faced with the opportunity and therefore the need to maintain as best as possible the universal and inclusive objectives upon which our National Health Service is based, and precisely for this reason it is essential to continue to contrast the need to optimize the services provided (and not only on the economic-financial level, but also on that of managing good quality services) with the needs of a demand that is growing quantitatively and is becoming increasingly difficult to satisfy. We need a clear and comprehensible new assumption of responsibility by both parties to help us not merely celebrate the 40th anniversary of the National Health Service, but also to imagine a realistically sustainable profile for the future.

Ermeneia - Studi & Strategie di Sistema is a company that specializes in providing analytical and consulting activities to trade associations and public and private clients, including those operating in the healthcare service sector, who are actively redesigning their presence and operational methods to remain in step with progressive changes in Italy.

AIOP - Associazione Italiana Ospedalità Privata (Italian Association of Private Hospitals) is a trade association that represents private healthcare facilities and hospitals, accredited or otherwise, throughout every region of Italy, which employ just over 70,000, accounting for 11% of the operators of the entire system, who provide hospital services to 15% of patients.