[Access to medicines and inadequate calculation of supplementary healthcare]

The claim that a universal National health service (Nhs) is unsustainable is frequently accepted as fact, yet pharmaceutical care in Italy demonstrates otherwise. Italy ranks among European Union leaders in public drug access, contradicting the narrative of Nhs unsustainability. Achievements stem from national strategies in drug evaluation, reimbursement criteria, price negotiation and the presence of a competitive context. Private pharmaceutical spending remains substantial, mainly because of lack of price negotiation. Shifting drug costs to citizens and promoting private insurance would increase both private and public expenditures. The US example shows that higher private spending correlates with higher public spending. Reducing Nhs coverage would worsen existing challenges rather than solve them.