The Health & Hospitals Report/2019, now in its 17th edition, provides an account - year by year - of the state of affairs of our mixed hospital system, which consists of a publicly-operated component (comprised of different types of institutions) and a privately-operated component (itself made up of different types of accredited facilities) .
It is an organization made up of a thousand hospitals, with 190,000 patient beds, that treats eight million acute patients annually, with inpatient admissions and day hospital admissions, as well as 500,000 people who use rehabilitation and long-term care facilities: it employs more than 600,000 workers and has a total expenditure of EUR 63.6 billion, which amounts to 55.7% of total public healthcare spending.
It should be recalled that the Report has two distinctive features.
On the one hand, it aims to understand the level of satisfaction of users and citizens with respect to their healthcare needs and, therefore, the functioning of the hospital "machine".
On the other hand, it is prepared by a "third party", who analyzes and independently evaluates the trend of the experiences and opinions of the population, as well as the performance of the hospital facilities.
The focus this year has been on the difficult pursuit of an acceptable "average level" of services to be provided in terms of time, quality, and territory (and individual hospital and post-hospital facilities).
Yet this is not the case, despite the average statistical results showing an increase in the complexity of the services offered and their effectiveness over time: indeed, the statistical average comes up against an "average level" that is not yet effective, acceptable and widespread, as confirmed by the measured phenomena.
In particular, there is the significant increase in 2019 of people on waiting lists and for longer times, compared to the already problematic situation in 2018, the progressive weariness of users following the de-hospitalization process that over the years has made patients "bounce" from hospital inpatient admissions to day hospital services, and then from the latter to outpatient day services; and there has also been the pronounced deterioration, over the last 5 years, of the "connection" systems between general medicine and hospitals and between these and post-hospitalization services (rehabilitation, long-term care, assisted living homes and home care service).
The assessment of the hospital "machine" also reported the persistence of a system defunding process, which has been underway for some time now, which places Italy at the bottom of the list of public healthcare spending out of GDP compared to the average of OECD countries. To this situation must be added the evidently problematic inefficiencies generated by the publicly-operated component, exactly as shown by the five-year monitoring of the Hospital Centers' Income Statements.
The solution to the dilemma, represented by the continuous increase in the needs and expectations of patients and citizens, on the one hand, and the parallel process of the ongoing defunding of the system, on the other, requires a realistic rewriting of the Pact between the State and Citizens, in terms of health protection (and welfare as a whole): the Cognitive Maps of the past are no longer enough to interpret the present and, even less, they are used to plan the future of a system that aims to actually preserve the universal and inclusive care objectives on which the NHS has been based since its foundation.

Ermeneia - Studi & Strategie di Sistema is a company that specializes in providing analytical and consulting activities to trade associations representing interests 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 hospital facilities of the privately-operated component of the NHS and private healthcare facilities, 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.