Italy could see its estimated 5 billion ($6.34 billion) of healthcare securitization deals executed by several of its southern regional governments tallied up as on balance sheet debt. That's if Eurostat moves ahead with its recent initiative outlined in a letter issued earlier this month. The 5 billion euros would add about 0.5 of GDP to the state debt, which is the world's third biggest in absolute terms.

"In terms of their balance sheet treatment, these transactions are under review by Eurostat," said Phillip Walsh, a senior director at Fitch Ratings, during a teleconference the rating agency held last week. "Eurostat issued a letter last week suggesting that these deals will not benefit from off-balance sheet treatment in the future. It's not clear if that is specific to any one transaction or all transactions in general but there is clearly some work to be done there."

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