In our country, which is increasingly characterized by a steady decline in the birth rate, starting a family is still an obstacle course. We think of all the couples who need to resort to assisted fertilization techniques in order to become parents, forced to face a thousand bureaucratic difficulties, rules and costs that differ from region to region.
Access to heterologous fertilization (an in vitro fertilization technique with one or both gametes from an external donor), for example, is not uniform in all public facilities in the country. Let’s take the case of Sicily where this technique, although allowed by law also in public facilities, is in fact practiced only by private centers because in the public there are no gametes available from donors and if a couple decides to go outside the Region, they do not have right to reimbursement paid by the Regional Health Service.
After all, only in 2017, for the first time, assisted fertilization techniques were included in the LEA (Essential levels of assistance), i.e. all those services that the National Health Service (SSN) is required to provide to all citizens, free of charge. or upon payment of a ticket. Since then, however, no tariff nomenclator has been issued for these techniques and some investigations are still excluded. The LEAs have not yet been updated and the PMA services paid by the NHS continue not to be concretely applicable, nor in line with the needs of the people.
A recent draft of a ministerial decree sent to the State Regions Conference, however, instead of remedying the existing non-compliance and inequalities, has made access to care even more discriminatory, starting with the proposal on the rates for PMA services (medically assisted procreation ) with a forecast of reimbursement of approximately 1,360 euros, without however even specifying the distinction between homologous and heterologous PMA (different techniques involving different costs). Moreover, the same ministerial table set up on this issue had established that the minimum reasonable rate for the performance of PMA is equal to 2,700 euros. But the decree also lacks the indications of the actual economic coverage for each phase of the medically assisted procreation process. All this would involve the displacement of the provision of services solely in a private regime with the risk that the phenomena of so-called “procreative tourism” will reappear to other EU countries for which couples will be entitled to receive any reimbursement – since the centers are not able public and private agreements support the provision of the service at values lower than the actual cost of the same.
The document then confirms the exclusion of pre-implantation diagnostic investigations on the embryo before transfer to the uterus (an examination that can avoid the risk of transmitting the genetic disease of which one is affected or a carrier to one’s child) and does not provide for reimbursements for donors. of gametes. Omissions that limit the application of lawful techniques in Italy, which continue not to be provided by the NHS but only at the expense of regional health, with enormous territorial differences. The result is a strong inequality in access to care and respect for the right to health for all couples who need it.
For this reason, the Luca Coscioni Association already in 2020 with the Associations of patients who need to access assisted fertilization, had written to the Minister of Health Roberto Speranza to report all the non-compliance and discrimination produced in the field of assisted fertilization. Now the Association has warned the Ministry of Health from approving the decree, for the part relating to the rates of medically assisted fertilization, asking that the fertilization tariff nomenclator be immediately integrated with the pre-implantation surveys; that reimbursements are foreseen for gamete donors as in all EU countries, where even the marketing of gametes and embryos is prohibited as in Italy; that reasonable rates are provided for each individual service.