Expenditure On Retail Pharmaceuticals Per Capita in US$ PPP, 2019: $659

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

Expenditure On Retail Pharmaceuticals By Type Of Financing, 2019 (%)
Government/Compulsory Plans: 62%
Voluntary Health Insurance Plans: 0%
Out-Of-Pocket: 38%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“In 2011 total expenditure on pharmaceuticals reached €26.3 billion, with a share of 75% reimbursed by the SSN and distributed mainly by public and private pharmacies (AIFA, 2011). Pharmaceutical expenditure per capita (including SSN-reimbursed drugs dispensed by public and private pharmacies and co-payments) increased overall by 2.5% in the period 2001–2010. A difference between northern and southern regions is evident, with all southern regions presenting higher levels than the national average of €215 per capita.

“Average national consumption by defined daily dose (DDD) of products reimbursed by the SSN is 952 (per 1000), having increased by 2.8% in the period 2009–2010 and by 41.3% compared to 2001 (Montilla et al., 2011). Data analysis by age group reveals that drug use by people aged 75 and over is 17 times higher than the group aged 25–34 (Osservasalute, 2012), highlighting that age is the most predictive factor of drug consumption. Furthermore, drugs acting on the cardiovascular system are the most frequently prescribed (47.4% of total consumption). The consumption of generics (by DDD) has more than tripled in the period 2002–2010, increasing from 14.0% to 51.5% (of the total consumption of SSN). In parallel, during the same period, expenditure on generics increased from 7.0% to 30.4% of total pharmaceutical expenditure. Finally, analysis of antibiotic consumption shows that Italy is among the European countries with the highest use – 27.3 (DDD/1000) in 2010 (Cangini et al., 2011). The wide variability between northern and southern regions is also worth noting, with higher rates in the south.”

Source: Ferré F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: Health System Review. Health Systems in Transition, 2014, 16(4):1–168.

“Ceilings for reimbursable pharmaceutical spending in retail pharmacies were first introduced in 2001. These were initially capped at 13 % of total health expenditure per year at both national and regional levels, then reduced to 11 % in 2013 and to 8 % in 2017. In 2003, spending ceilings were also introduced for medicines delivered by hospital pharmacies for inpatients and outpatients. The ceilings for hospital pharmaceutical expenditure were initially set at 2.4 % of total health expenditure, but then increased to 3.5 % in 2013 and 6.9 % in 2017. These increases reflect the fact that new medicines used in hospitals are becoming more costly. For example, expenditure on cancer drugs increased by 12 % from 2016 to 2017, accounting for almost 23 % of total public pharmaceutical expenditure in the country in 2017 (AIFA, 2018).

“To avoid overspending, some agreements between industry, regions and the NHS have been established. If the ceiling on community pharmacy expenditure is exceeded, the industry (manufacturers and distributors) is liable to refund the excess spending to the NHS – a mechanism known as ‘pay-back’. If the hospital inpatient expenditure cap is exceeded, the regions and manufacturers are liable to refund 50 % each of the excess expenditure to the NHS.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“To improve value for money in pharmaceutical spending, Italy has implemented a series of measures to promote greater use of generics. Unless a reason is provided by the doctor to preclude substitution, the pharmacist must mention to customers if a cheaper equivalent product exists. If the doctor indicates that the medicine is ‘not substitutable’ or if the customer insists on purchasing the brand name, the customer must pay the difference between the price of the dispensed medicine and the cheapest alternative.

“Between 2005 and 2017, the generics market share in Italy increased from 7 % to 25 % in volume (Figure 22). Nevertheless, the share remains well below the EU average, in part because pharmacists are remunerated according to a fixed percentage of the price of each product, which creates a disincentive for them to dispense (cheaper) generic medicines.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Sept. 20, 2022 by Doug McVay, Editor.