Towards Sustainable Healthcare: The Crucial Role of Prevention

Italy’s rapidly aging population poses significant challenges to its healthcare system. With over 23% of the population now aged over 65, the incidence of chronic conditions such as diabetes, heart disease, and dementia is rising steadily, demanding increasingly complex and costly care. This situation requires a fundamental shift in how we allocate healthcare resources, placing greater emphasis on preventive and innovative solutions that ensure both economic sustainability and improved quality of life for all citizens.

Statements from the media claiming that we need to “spend more on healthcare” are often rhetoric, disconnected from the reality experienced by patients and families dealing with long waiting lists, regional disparities in care quality, limited resources, and a fragile system under strain. In a country burdened by high public debt and record levels of taxation, increasing healthcare funding is far from straightforward. However, there is still room for action, particularly through investment in prevention, which can help relieve pressure on the healthcare system and free up resources for where they are needed most.

Our recent research offers a compelling perspective on how to confront these challenges. By analyzing data on nearly 97,000 patients hospitalized for acute myocardial infarction between 2007 and 2022, we found that healthcare spending prior to hospitalization, particularly pharmaceutical spending, can significantly reduce mortality.

The evidence is clear: a 10% increase in pharmaceutical spending in the year before hospital admission is associated with a 2.7% to 3% reduction in in-hospital mortality. These numbers indicate that preventive care can save thousands of lives annually. Patients who receive appropriate care before a major cardiac event are more likely to arrive at the hospital in better condition, which significantly improves survival chances.

In contrast, while hospital spending remains essential, its impact is most relevant in more severe cases, such as those involving high levels of cardiac necrosis. Pre-hospital outpatient visits, though helpful, are not as effective at reducing mortality unless incorporated as part of a well-structured and targeted care program.

Why is prevention so crucial? From both ethical and economic standpoints, prevention is more effective than cures. Investing in preventive care reduces the burden on hospitals, lowers intensive treatment costs, and improves patients’ quality of life. Preventive care is especially impactful when it comes to chronic diseases, which are among the leading causes of hospital admission and death in Italy.

One concrete example is the management of heart disease. Patients who receive proper medications and preventive care not only avoid serious complications but also reduce the need for costly hospital interventions. Achieving this requires an integrated approach involving general practitioners, specialists, and healthcare facilities that all work in close coordination.

How can we improve? Our research highlights several concrete actions that could make a meaningful difference. First, we must increase access to medications by removing economic and logistical barriers and encouraging patients to adhere consistently to preventive treatments. Health education is equally critical: informing citizens about the importance of prevention and proactive health management can significantly reduce untreated chronic conditions.

We also need to provide incentives for primary care. It is essential to strengthen the role of general practitioners and equip them with the tools and resources to manage chronic conditions more effectively. In addition, we should promote personalized prevention plans. Since every patient has different needs, preventive care must be tailored accordingly. Customized programs can improve clinical outcomes and reduce overall costs.

Making this shift requires political leadership with a long-term vision. Redirecting resources gradually from emergency care to prevention—especially in primary and community care—is key. Innovation should also play a central role, leveraging digital technologies to monitor patients’ health and prevent disease progression. One promising example is the use of early warning indicators, such as pharmaceutical data, to detect emerging health problems and intervene before they become critical. When combined with smart data analytics, these tools can anticipate and respond to the healthcare needs of a rapidly evolving population.

In conclusion, our recent studies offer a powerful lesson: prevention is not just a wise choice—it is a necessity for building a sustainable and high-quality healthcare system. Investing in medications, preventive care, and coordination among healthcare providers can save lives, lower costs, and improve system efficiency. Only through a strategic, collaborative approach can we meet the challenges ahead and ensure that all citizens can enjoy long, healthy lives.

* Francesco Moscone is a professor at Brunel University of London and Ca’ Foscari Università di Venezia; Elisa Tosetti is a professor at the University of Padua; Giorgio Vittadini is a professor at the University of Milan-Bicocca. Prof. Moscone acknowledges funding from the project n. PE0000015 entitled “Age-It - Ageing well in an ageing society”, funded by Next Generation EU - National Recovery and Resilience Plan (NRRP) - PE8 - Mission 4, C2, Intervention 1.3. Prof. Tosetti acknowledges funding from the PRIN project n.2022CZKPMY entitled "Health and Wellbeing of the Elderly," funded by the MUR