Financialisation and the National Health Service in Italy

In Italy, healthcare is one of the public welfare sectors that has been most deeply affected by marketisation and privatisation processes since the reforms of the 1990s. The dynamics of financialisation also find favourable ground in this context, thanks to so called “health funds”. In recent years there has been continuous growth in the number of their beneficiaries, which almost doubled between 2014 and 2020.

The success of health funds is linked to two reasons. On the one hand, the difficulty of the public health service in responding to citizens' health needs is manifestly increasing. On the other hand, taxation mechanisms associated with health funds make them very attractive to employers who use them as instruments for wage bargaining.

The literature has highlighted many problems concerning health funds, mainly related to four issues: (a) with respect to the function, which ends up being a substitute rather than a supplement to the NHS; (b) with respect to the redistributive effects, since they focus on specific categories of workers or types of companies, thereby increasing inequalities in access to health services c) with respect to financing, which due to special regime of taxation is de facto a mechanism of drainage of public resources, moreover not explicit; d) with respect to the demand for health, because of the tendency to provide superfluous services.

After reconstructing the state of the art of sociological studies and the European debate on the spread of health funds and health insurance, the paper focuses on Italy to discuss some initial findings regarding:

(a) the relationship between public and private: regulatory mechanisms and powers;

1. b) the dynamics concerning equality/inequality in access to health services and the right to health and care;
2. c) the ethos of financialisation;
3. d) the specificities of the Italian case: historical heritage and territorial gaps.