Every health, technological or environmental crisis leaves behind a trail of costs and inefficiencies. Yet, in healthcare and public administration, prevention continues to be perceived as a technical expense rather than a value driver. Assessing its economic and financial impact, however, allows it to be transformed into a strategic choice and a policy of trust toward citizens.
A recent analysis conducted on 133 Italian municipalities with more than 50,000 inhabitants (2016–2022) showed that investments in prevention increase mainly after an emergency or crisis—evidence that highlights how urgent it is to bring prevention back to the core of public policy.
Prevention costs, but not preventing costs more
There is a silent paradox running through healthcare and public administration: everyone acknowledges the importance of prevention, yet almost everyone treats it as an optional, "non-urgent" item. And yet, every crisis—health, cyber, or climate-related—reminds us that the cost of not preventing far exceeds the cost of prevention.
Examples, unfortunately, abound. The ransomware attack that in 2017 paralyzed the British National Health Service cost £92 million (National Audit Office, 2018). In the 2023 floods in Emilia-Romagna, ex post assessments estimated around €8.5 billion in direct and indirect damages, based on precise indicators such as days of lost productivity, agricultural losses, and infrastructure damage. In Italy’s Regional Health Services, the main emergency cost drivers during 2019–2023—particularly Covid-19, energy price hikes, and market risks—generated an average cost increase of 14%, showing how extraordinary factors can quickly become structural components of regional healthcare budgets. Every time, the same dynamic emerges: resources are found to repair, but rarely to prevent.
What the data tell us
The analysis conducted on 133 Italian municipalities with more than 50,000 inhabitants for the period 2016–2022 showed, through a regression model, that the main determinants of preventive spending are financial availability, exposure to hydrogeological and landslide risk, building conditions, and—above all—past experience of disasters. In other words, municipalities that have suffered a natural event tend to increase preventive investments in subsequent years. Prevention, therefore, does not stem from planning but from the memory of crisis.
Spending on prevention accounts for on average less than 0.5% of municipal budgets, with strong regional disparities (source: authors’ elaboration on SIOPE data, 2016–2022). Regions with higher hydrogeological or seismic risk invest more—but often only after a catastrophic event. Larger municipalities, with greater financial capacity, record higher average per capita spending on prevention (about €14 per year) compared to the national average of €10–11.
How to measure the economic value of prevention
When it comes to the economic value of prevention, the typical reaction is skepticism: how can we measure something that doesn’t happen? Yet in public economics and cost–benefit analysis, what is avoided—indirect costs, inefficiencies, reputational impacts—has always been measurable. Evaluating prevention means building an economic language for long-term decision-making.
It must be recognized, however, that different metrics and evaluation approaches apply depending on the level of analysis. At the macro level (e.g., the European Union or member states), systemic impact and collective well-being indicators are used; at the meso level (territories, regions, cities), economic–social performance and service continuity metrics prevail; at the micro level (organizations, healthcare companies, single administrations), the analysis focuses on avoided costs, recovery times, productivity, citizen trust, and reputation.
This plurality of perspectives calls for contributions from multiple disciplines: economics, for assessing returns and avoided costs; management and organization studies, for measuring process and structural resilience; and technical and engineering disciplines, for estimating physical and infrastructural risks. Prevention, therefore, is not only an economic investment but also an interdisciplinary and multilevel competence.
From theory to practice
An investment of €500,000 in an IT backup system can prevent shutdowns worth €2 million: a positive return, but above all an invaluable reputational and operational advantage. The same holds true for predictive maintenance of medical equipment or staff training: what appears to be a recurring cost is, in fact, an insurance policy for service continuity.
Prevention must be read within processes, not only in budget lines. Every organization—whether a healthcare company, local authority, or ministry—can identify within its operational flows the points where vulnerabilities (and therefore opportunities for improvement) arise. When prevention is integrated across governance levels—strategic, managerial, and technical—it ceases to be a defensive practice and becomes a shared organizational competence.
Conclusion
In healthcare and public administration, assessing prevention is first and foremost an act of accountability: it means making visible what often remains invisible—the value of time saved, damages avoided, and trust built. Prevention costs, certainly. But not preventing costs much more—in money, in reputation, and above all in citizens’ trust. And perhaps, in this turning point of our era, this is the highest form of public leadership: investing in the future before an emergency forces us to.
