Abstract Chapter 4
Chapter 4 examines in depth the role of the private entities that provide healthcare services on behalf of the Italian NHS (“accredited” providers). In 2017, the expenditure for overall assistance provided by accredited private entities was equal to 18.8% of the total INHS expenditure. This level has been stable since 2012 and exhibits pronounced inter-regional differences. Overall, private hospitals provide 30.2% of INHS beds and hold an average of 116 accredited beds, with over 60% of hospitals under the 100 beds threshold. The contribute of private providers appears minor in acute care (22.8% of total INHS beds), equivalent to that of public providers in inpatient long-term care (53.0%), prevalent in rehabilitation (74.0%). With regard to the activities, admissions to private hospitals represent about 26.5% of the total INHS admissions, with a regional maximum registered in Lazio Region (51.2%). Between 2013 and 2018, market concentration has grown: big hospital players, that hold at least 500 beds along their network of structures, have acquired over 2.000 new beds and 21 new hospitals. As a result, big hospital groups now hold 38.0% of total accredited beds and 11.5% of the overall INHS capacity. Furthermore, such groups have increasingly been pursuing vertical integration strategies along the industry chain developing forms of collaboration with universities, health and social community structures and outpatient clinics. Moreover, 12 of the 20 groups analysed secured the IRCCS recognition for at least one of their hospitals. In the light of the interviews performed with representatives of some hospital players, it is possible to identify the main strategic trajectories currently pursued: expansion through the acquisition of small structures; search for new “blue oceans” (international patients, wellness centres, new outpatient settings); closer integration with rehabilitation and chronic care settings; increased attention to quality through cooperation with academic and research institutions; development of specific and selective partnerships among independent hospital players, and with the insurance sector as well.