The "Health & Hospitals" Report, in its 20th edition, offers annual monitoring and assessment of the effectiveness and efficiency of the Italian hospital system, recognizable by its mixed nature, comprising a public component and a private component. It is a hospital "machine" that makes a total of 185,000 beds available, of which 129,000 belong to public facilities and 56,000 to accredited facilities, which handled around 8 million inpatient stays per year up until the pandemic hit, dropping down to 6.4 million in 2020 in light of the need to prioritize the Covid-19 emergency.
Despite the decrease in services, especially regular services, due to the pandemic, the National Health Service still provided more than 48 million days of hospitalization, of which 71.7% were in public hospitals and 28.3% in private hospitals. The related public hospital expenditure in 2020 totaled EUR 69.3 billion, representing 56.2% of total public healthcare spending.
The Report has accompanied the National Health Service over the past 20 years of its 44-year lifespan, offering an updated, reasoned analysis based on objective data, ensuring the "third-party nature" of the evaluation, thanks to its being entrusted to an external, autonomous and independent entity, and adopting a dual-assessment perspective that takes into account both the point of view of demand (i.e. users and their healthcare needs) and the point of view of supply (i.e. the healthcare "machine" and its evolution over time).
In the hopes that the 2022 edition represents the closure of the complex three-year period of the pandemic, we wanted to describe this unprecedented interval, the more or less direct effects of which are destined to linger for a long time to come: the extraordinary emergency phase, dealt with in the year 2020; the proactive phase of 2021, characterized by the vast vaccination program and also by the interruption and postponement of services; and, finally, that of the year 2022, in which we found ourselves facing an aggravated phenomenon of postponed or as yet not provided services.
The Report demonstrates a significant increase in the phenomenon of waiting times and unsatisfied demand both through the analysis of current information flows and by means of a survey addressed to users of the NHS, with or without experience of the virus: the consequences are the "reactivity" - manifested essentially in the use of individual professionals and purely private services and the intramoenia services offered by public hospitals - but also the "passivity" of those who were forced to forgo treatment.
Out-of-pocket spending, which has always been a thorn in the side of our National Health Service, not only fails to be reabsorbed, but risks expanding even further, exacerbating inequities on a socio-economic basis between those who can and those who cannot afford it.
A common effort is increasingly necessary, the development of more convinced and transparent "purpose-driven alliances" between the public and private sectors in the NHS, implementing the positive collaboration experienced in the first year of Covid, to respond to the challenges posed by the "extraordinary" pandemic and to the by-now structural critical issues of a "regular system" called upon to renew itself.

Ermeneia - Studi & Strategie di Sistema (System Studies & Strategies) 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 hospitals that are part of the National Health Service and private healthcare facilities located throughout all Italian Regions, which employ more than 73,000 workers and, accounting for 11% of the operators in the entire system, provide for the healthcare needs of 15% of patients.