The 26th OASI Report – the Observatory on Healthcare Organizations and the Italian National Health Service – produced by CERGAS at SDA Bocconi School of Management, was presented today. The 2025 edition places a crucial issue at the center of the debate: a healthcare system increasingly required to meet growing and more complex needs with resources growing more slowly than demand, safeguarding universalism depends on the ability to define explicit priorities.

Overcoming “Comforting Narratives”

The Report urges policymakers to move beyond three recurring assumptions in the public debate – more funding, greater efficiency understood merely as downward spending alignment, and shorter waiting lists – arguing that they offer partial and insufficient solutions. According to OASI, the National Health Service can no longer “chase everything”: clear decisions are needed on whom to protect first, with which services, and at what level of intensity.

“In an ageing country, with a shrinking active population, the National Health Service must abandon reassuring narratives and find the courage to make choices,” says Francesco Longo, Scientific Director of the OASI Report.
Defining priorities, he adds, “does not mean reducing universalism, but protecting it,” because it is “the only way to generate value, reduce inequalities, and design a National Health Service capable of facing the challenges of the coming decades.”

Growing Needs and Structural Gaps

The Report highlights how demand for healthcare is outpacing the system’s ability to respond: only 60% of prescriptions result in services delivered within the NHS; more than 4 million older adults are non-self-sufficient, yet only 8% access residential care; significant differences persist across Regions in life expectancy and access to services; and the use of healthcare services varies in unjustified ways even within the individual areas of the same Region.

The “Governable Challenges”

Alongside structural constraints, OASI identifies five areas where the NHS can act immediately: reorganizing healthcare professions to attract more nurses; updating tariffs for accredited private providers; strengthening procurement capabilities; accelerating the digital transformation of General Practitioners and adopting a genuine “digital & remote first” model; and developing a multichannel approach to care that ensures continuity and avoids fragmentation between clinics, Community Health Centers and other territorial services.

The Management “Double Agenda”

In a context where political priorities remain largely implicit, the Report stresses that NHS managers today operate with significant room for autonomy — and equally significant responsibility.
“Managers can – and must – seize every window of opportunity to exercise a deeper form of responsibility,” notes Alberto Ricci, Coordinator of the OASI Report. This means “interpreting the trade-offs that politics does not articulate, deciding which services should be strengthened first, and governing demand as well as supply.”
According to Ricci, the so-called “double agenda” — the visible and the strategic one — becomes “the tool through which management can safeguard the sustainability of universalism, ensuring that priority responses reach those who truly need them most, even when the public debate looks elsewhere.”

OASI looks to Europe with HealthTech XPO

This year, the presentation of the OASI 2025 Report featured a dedicated parallel session within the third HealthTech XPO, promoted by HealthTech Europe — the largest European network of entrepreneurs, managers, researchers, investors and experts in digital and AI-driven health ecosystems.
The session offered an opportunity to explore how artificial intelligence, digital transformation and new business models are reshaping healthcare across Europe and beyond, highlighting both emerging opportunities and critical challenges in a rapidly evolving sector.

This collaboration confirms how OASI is increasingly expanding its outlook towards Europe, embracing the challenges posed by the digital transformation of healthcare and the growing impact of artificial intelligence on care systems.

SDA Bocconi School of Management