also following the economic crisis the central government imposed an obligation to adopt regional recovery plans in regions with the largest deficits piani di rientro which have proven to be effective in reducing deficits in this context and under a set of assumptions regarding the health of the population and future economic growth italys public spending on health care as a share of gdp is projected to rise modestly to of gdp in more recently the pact for health went a step further towards care integration requiring regions to establish primary care complex units comprising gps specialists nurses and social workers