State of Health in the EU Italy Country Health Profile 2017 European on Health Systems and Policies a partnership hosted by WHO The Country Health Profile series Contents The State of Health in the EU profiles provide a concise and 1 • HIGHLIGHTS 1 policy-relevant overview of health and health systems in the EU 2 • HEALTH IN ITALY 2 Member States, emphasising the particular characteristics and 3 • RISK FACTORS 4 challenges in each country. They are designed to support the efforts of Member States in their evidence-based policy making. 4 • THE HEALTH SYSTEM 6 5 • PERFORMANCE OF THE HEALTH SYSTEM 9 The Country Health Profiles are the joint work of the OECD and 5.1 Effectiveness 9 the European Observatory on Health Systems and Policies, in 5.2 Accessibility 12 cooperation with the European Commission. The team is grateful for the valuable comments and suggestions provided by Member 5.3 Resilience 13 States and the Health Systems and Policy Monitor network. 6 • KEY FINDINGS 16 Data and information sources The data and information in these Country Health Profiles are The calculated EU averages are weighted averages of the based mainly on national official statistics provided to Eurostat 28 Member States unless otherwise noted. and the OECD, which were validated in June 2017 to ensure the highest standards of data comparability. The sources and To download the Excel spreadsheet matching all the methods underlying these data are available in the Eurostat tables and graphs in this profile, just type the following Database and the OECD health database. Some additional data StatLinks into your Internet browser: also come from the Institute for Health Metrics and Evaluation http://dx.doi.org/10.1787/888933593627 (IHME), the European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the World Health Organization (WHO), as well as other national sources. Demographic and socioeconomic context in Italy, 2015 Italy EU Demographic factors Population size (thousands) 60 731 509 175 Share of population over age 65 (%) 21.7 18.9 Fertility rate¹ 1.3 1.6 Socioeconomic factors GDP per capita (EUR PPP2) 27 800 28 900 Relative poverty rate3 (%) 13.4 10.8 Unemployment rate (%) 11.9 9.4 1. Number of children born per woman aged 15–49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 50% of median equivalised disposable income. Source: Eurostat Database. Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors any territory, to the delimitation of international frontiers and boundaries and to the name of any and do not necessarily reflect the official views of the OECD or of its member countries, or of the territory, city or area. European Observatory on Health Systems and Policies or any of its Partners. The views expressed Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/ herein can in no way be taken to reflect the official opinion of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over © OECD and World Health Organization (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) Highlights . 1 1 Highlights Italy The life expectancy of Italian people is among the highest in Europe, although disparities exist across regions and socioeconomic groups. Under tight budget constraints, Italy has managed to reform and expand the national health benefit basket. The central government is also fostering a recentralisation of funding and designing a new system to allocate resources among regions to achieve the ambitious objective of providing access to this expanded benefit basket to all residents. Health status Life expectancy at birth, years IT EU Life expectancy at birth in Italy reached 82.7 years in 2015, up from 79.9 years in 2000, 83 82.7 which is the second highest in the EU after Spain. Life expectancy gains were driven 82 mainly by reductions in mortality from cardiovascular diseases. However, substantial 81 80.6 80 79.9 gender and socioeconomic status gaps persist. 79 78 77.3 82.7 77 YEARS 2000 2015 Risk factors % of adults in 2014 IT EU In 2014, 20% of adults in Italy smoked tobacco every day, slightly below the EU average Smoking 20% and down from 25% in 2000. Overall alcohol consumption per adult also fell and is well below the EU average. The proportion of adults reporting regular heavy alcohol consumption is also much lower than in most other EU countries. On the other hand, in Binge drinking 7% contrast to low levels in adults, overweight or obesity problems among children have % of children in 2014 IT EU grown and are now above the EU average. Overweight/ obese 18% Health system Per capita spending (EUR PPP) IT EU Health spending in Italy, at EUR 2 502 per capita in 2015, is 10% lower than the EU €3 000 average of EUR 2 797. This equals 9.1% of GDP, also below the EU average of 9.9%. €2 000 Although a core set of essential services are free, out-of-pocket spending is relatively high (23% compared to the EU average of 15% in 2015) and are mainly used to pay for €1 000 pharmaceuticals and dental care. €0 2005 2007 2009 2011 2013 2015 Health system performance Effectiveness Access Resilience Amenable mortality in Italy remains one of The Italian National Health Service A new system to the lowest in EU countries, suggesting that automatically covers all citizens and increase equity in the health care system is effective in treating foreign residents. However, access to regional health people with life-threatening conditions. health care in Italy varies largely by region spending has been and income group. designed. More nurses are being trained Amenable mortality per 100 000 population IT EU % reporting unmet medical needs, 2015 to tackle population ageing. New national 180 175 High income All Low income performance measurements are being 160 implemented to increase accountability 140 126 IT and improve quality of care. 120 118 100 90 EU 80 2005 2014 0% 8% 16% STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – ITALY 2 . Health in Italy Italy 2 Health in Italy Life expectancy at birth in Italy is the second Most of the life expectancy gains in Italy since 2000 were driven by highest among EU countries reduced mortality rates after the age of 65. Italians at age 65 can expect to live longer but with less disability-free years than other At 82.7 years, life expectancy at birth in Italy is the second highest EU people at age 65. In 2015, an Italian woman at the age of 65 in the EU (after Spain) and two years longer than the EU average has a life expectancy of 22.2 years, while the life expectancy of a (Figure 1). Life expectancy at birth increased by 2.8 years between man at the same age is 18.9 years. At age 65, women can expect 2000 and 2015. As in other EU countries, a substantial gender gap to live only about one-third (7.5 years) of their remaining life free remains, with life expectancy for women about five years higher of disability, while men can expect to live about 40% (7.8 years) of than for men. Disparities by socioeconomic status also persist. the rest of their life disability-free.2 Highly educated Italians have a life expectancy at birth that is four years higher than Italians who have not completed their secondary education.1 Figure 1. Life expectancy at birth in Italy is two years above the EU average Italy Years 2015 2000 90 82.7years of age 85 EU Average 80.6 years of age 83.0 82.7 82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6 80 78.7 78.0 77.5 77.5 76.7 75.7 75.0 74.8 74.7 75 74.6 70 65 60 EU Italy Spain Malta Latvia France Cyprus Poland Ireland Greece Austria Croatia Finland Estonia Sweden Belgium Bulgaria Portugal Hungary Slovenia Romania Denmark Germany Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Source: Eurostat Database. Mortality continues to be driven by Deaths from Alzheimer’s disease and other dementias have cardiovascular diseases and cancer increased substantially since 2000, due to population ageing, but also as a result of better diagnosis and an improved recording of Close to two-thirds of all deaths in Italy were attributable to either different forms of dementia as the primary cause of death. cardiovascular diseases or cancer in 2014 (Figure 2). Cardiovascular diseases represent the main causes of death among women (40%) followed by cancer (24%), while for men one-third of deaths are Italy is facing a high burden of chronic related to cardiovascular diseases and another one-third to cancer. conditions mainly related to population ageing … When looking at trends in more specific causes of death, heart diseases and stroke continue to be the leading causes in 2014 In addition to the high burden of disease caused by cardiovascular (Figure 3). Lung cancer is still the leading cause of cancer mortality, diseases and cancer, musculoskeletal conditions (including low back followed by colorectal cancer, breast cancer and pancreatic cancer.