Abstract Chapter 7
National healthcare systems are increasingly strained by expanding demands of services, whilst growth rates of available resources are flattening. Therefore, understanding the health status of a population represents an important step in order to understand the efficacy, but also efficiency, in the provision of services. Being aware of the complex and multidimensional network of health states determinants, Chapter 2 provides an overview of the main health outcomes indicators for the Italian population, using data from national and international sources. The chapter starts with an international comparison, followed by a more in-depth analysis across Italian regions, with a specific focus on life expectancy, mortality, perceived health status, unsatisfied healthcare needs and diffusion of the main risk factors. An analysis on the association between mortality for specific causes of death and some socio-economic variables is then presented. Overall, the comparison with other countries (in particular, United Kingdom, USA, Spain, Germany and France) in terms of main health indicators is reassuring for Italy. In addition, the proportion of people who declare unsatisfied healthcare needs is declining. At the national level, the long-run trend of mortality rates declined between 2003 and 2015 (between -1.3% and -2.2% per year), although the number of deaths for mental disorders and nervous system diseases sharply increased (up to +5.8% per year). On the other hand, a geographical gradient can be observed with the North of Italy reporting better outcomes for many indicators (i.e. spread between life expectancy and healthy life expectancy goes from 30.6 years in Calabria – a Southern region - and 14.1 years in Bolzano – a Northern region). Finally, a negative association was observed between income increase at population level and reduction of mortality, especially for cardiovascular diseases. During the last decade, regional healthcare systems in Italy have focused on cutting expenditure due to budgetary constraints. However, the structural consolidation of the financial performance achieved within a context of permanent – if not escalating – differences among different areas of the country, calls for the promotion of a “proactive NHS”, in contrast to a reactive one, so as to improve equity in the access to healthcare services and gradually reduce the observed gaps.