Minister Giancarlo Giorgetti at Insubria: “The challenge is to turn subsidiarity and sound public finances into healthcare that reaches people”

Minister of Economy and Finance Giancarlo Giorgetti was a guest of the University of Insubria this morning, as part of the www.uninsubria.it/incontro-sussidiarietà. His full speech is published below; the video is available at https://www.uninsubria.it/giorgetti-sussidiarieta

ADDRESS BY MINISTER GIANCARLO GIORGETTI

I would like to thank Giorgio Vittadini, Rector Pierro and the University of Insubria for the invitation.

Being here in Varese to discuss this Report has a deep meaning for me.

Here in our area, autonomy and subsidiarity have always gone hand in hand with responsibility.

Healthcare is one of the testing grounds on which citizens judge, every day, whether institutions are keeping their promises. The promise of the National Health Service is to provide care according to need and to make healthcare accessible to everyone. The merit of this Report is that it asks what needs to be done to keep that promise.

The authors’ answer is subsidiarity, which means two things. First, every task should be entrusted to whoever is closest to the need and best able to address it. Second, whoever takes on that task is accountable for it.

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Let me start with needs. We are living longer, and we are living longer with illness. Twenty-four million Italians have a chronic condition. For these patients and their families, the issue is not a single healthcare service: it is being supported over time, outside the hospital. To achieve this, it is not enough simply to ask for and obtain more resources: organisation is needed.

The Report makes this very clear through the example of stroke: the hospital works well, rehabilitation is struggling, and returning home leaves families on their own.

Subsidiarity helps us build a network in which, at every stage, there is someone who takes responsibility: the family doctor, the nurse, the municipality, the Third Sector organisation working in that neighbourhood, the family, supported rather than left alone.

Subsidiarity, when applied to care and to taking responsibility for patients throughout their care pathways, therefore means something very specific: rebuilding the entire pathway around the individual and assigning each stage to whoever is best placed to take responsibility for it.

The public sector, for its part, must renew its tools.

I believe that public healthcare today needs a strong injection of healthcare management engineers, to give priority to service organisation and process optimisation. When someone leaves hospital, they must know who will look after them at home: that certainty is part of care. Otherwise, the system places on the patient a burden that should have been borne by the system itself. And those with fewer resources give up sooner: six million people, the Report recalls, have foregone visits or examinations because of waiting times or costs.

The same applies to prevention, waiting lists and emergency departments.

The question is simply: who is responsible for what happens before and after the healthcare service is provided?

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Don Giussani spoke of initiatives that emerge in response to a need. The Report describes many such experiences, often originating in Lombardy, where subsidiarity has helped shape the healthcare system: freedom of choice and a plurality of providers.

To develop experiences like these, the Report proposes supplementing tariffs with a care budget.

This is the right direction, following the approach we set out in the Public Finance Document in April: in healthcare, costs are visible within the year, while benefits emerge over several years. Let us start with selected chronic disease pathways, with a person responsible for the pathway, a budget and an assessment of results.

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Let us turn to resources. For 2026, the Government has increased funding for the National Health Service to €142.9 billion, more than €6 billion above 2025. But citizens do not measure healthcare in billions.

For this reason, I share the Report’s central argument: continuity of care must become an identifiable responsibility. And those who manage services must be accountable for care outcomes as well as for financial balance.

The additional €6 billion allocated by the Government are an important prerequisite; the real test of the impact of these resources is when and how they become care. Of course, resources are a prerequisite; they produce results when and how they are turned into care. This is the primary responsibility of those who organise and manage services.

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The second responsibility lies with those who govern local areas. Whoever asks for the freedom to make decisions accepts responsibility for those decisions, including financially: greater autonomy and greater responsibility, not one without the other.

The right to healthcare is the same throughout Italy, and national solidarity is needed to guarantee it where local resources are insufficient: that is right.

But those who receive that solidarity are responsible for how they use it, while those who want to offer more must explain how they will pay for it.

Subsidiarity and responsible federalism go hand in hand. Separated, they do not work: subsidiarity without responsibility becomes uncontrolled spending; federalism without subsidiarity becomes a way of shifting costs onto others.

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Let me return to the area that concerns me most directly: fiscal stability.

As the Report reminds us, subsidiarity does not only mean moving responsibilities downwards: some functions must be carried out at the highest level. Protecting the country from the cost of debt is one of them. This is where subsidiarity meets sovereignty.

A country’s priorities are decided through its budget, and a country is sovereign if it can choose those priorities for itself.

Two weeks ago, in Cernobbio, I said that prudence on debt is a form of pragmatic sovereigntism. I repeat it here: sovereignty is exercised by keeping public finances in order.

Italy has €3 trillion in debt, equivalent to 137 per cent of GDP: it can make its own decisions as long as it retains the confidence of those who lend it money; if it loses that confidence, its priorities will be dictated by its creditors.

Today, that confidence is there. The spread has remained stable, the credit rating has improved, and the interest savings are the resources we have been able to put aside and use to increase the healthcare fund.

The point is simple. There are two types of spending in the public budget. The first is not a choice: interest on debt, which in 2025 amounted to 3.9 per cent of GDP, almost €90 billion. It is paid first, it is not subject to a vote and it cannot be postponed. The second type is spending we choose.

Every additional euro spent on interest is one less euro available for useful spending. And interest payments do not treat anyone.

This is not theory: it is history. The two times in which healthcare spending slowed down, from the 1990s to today, were after the financial crises of 1992 and 2011: between 2012 and 2019, the Report recalls, around €40 billion in cuts.

When a country loses control of its debt, it no longer chooses: it has to endure the consequences.

I say this in front of people who have built initiatives for those most in need: a balanced budget is a redistributive choice before it is an accounting choice.

Interest payments pay for the past. Useful spending goes to those who need it, first and foremost to those who could not afford to pay for their own healthcare. A budget weighed down by interest payments makes across-the-board cuts. Only a balanced budget can afford to be selective and support what works.

This is the part that the State must take care of.

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Finally, there is the role of families. Italians spend €41 billion a year out of their own pockets on healthcare, and for 8.6 per cent of households these expenses are unsustainable. This is why the Report calls for supplementary healthcare arrangements to be properly governed.

I believe we need to strengthen and better organise the role of healthcare funds and pension funds. For healthcare funds, tax benefits should be linked to the protection actually provided to members. For pension funds, lifelong coverage for long-term care should become a component of every pension plan. Being able to rely on a higher pension in the event of long-term care needs is a step forward in terms of social progress and financial education, and one that I feel obliged to encourage.

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Giorgio,

I suggest that we start from the experiences you have collected, together with those who implement them and with the Regions, and turn them into concrete proposals: the rules that need to be changed and the way to fund the work that ensures continuity of care.

Let us test them and evaluate them over time, not only on the basis of today’s costs: the cost of missed prevention does not appear in any budget, but it is paid nonetheless.

The Report proposes a new social pact for health. I am on board, on one condition: that the budget is part of that pact too. Subsidiarity, responsible federalism and pragmatic sovereigntism are three names for the same principle.

Subsidiarity allows the system to make the most of those who are closest to people’s needs. Responsible federalism asks those who receive resources to be accountable for them, including financially. Pragmatic sovereigntism safeguards, at the highest level, the freedom to choose that makes the other two possible.

From the neighbourhood, to the small municipality, to the national budget, the idea I also take from this year’s Report is that of a country in which everyone does their part and is accountable for it.

The challenge for the coming years is to turn sound public finances into healthcare that reaches people.

Varese, where autonomy and responsibility have always gone hand in hand, is the right place to say this.