[European evolution of the copayment in health costs: possible developments and reorganization proposals for Italian health care system. The role of additional kind of assistance].

The ticket, once considered just dissuasive or control instrument, has become citizens sharing of the costs of activities, services and performance of NHS. The difficult economic situation, that applies the main European countries, is leading in Italy to an increase measures of copayment. The use of over-sharing may drive, however, to important consequences in terms of equity, efficiency and cost containment of health. Copayment does not reduce the overall burden of spending, because often counterbalanced by a concomitant increase in private spending. In fact, Italian private expenditure on health "out of pocket" is the highest in Europe and more Italians discover the "low cost health care." The Authors propose to limite the introduction of new ticket or exacerbate the existing, focusing on the adherence of citizens to health and social integrative funds, that are now present on the national scene with about 5 million of members.