To this dynamic of comparison are also added the opinions of other stakeholders such as trade and professional associations, who are given a certain value “from above” for a specialist service. The passage to the State-Regions Conference was what was supposed to close the circle for the final approval of the tariff. It took six years. However that happened, the reputation of the NHS suffered.
But what happened in the meantime? «The system went ahead anyway, highlighting the differences between the different regional systems. Those with more resources, through the so-called extra Lea, autonomously included some of the services envisaged in the new updated list in their regional tariffs, financing them with their own income. Performance that other regions could not afford. This is one of the reasons why it has spread the phenomenon of healthcare mobility, whereby patients move from one region to another to receive treatment which on paper would also be foreseen and payable in one’s own territory”.
Now that the tariff decree has been approved, at least on paper the problem is solved but, as the associations that had mobilized permanently to at least achieve this result immediately noticed, the road is still long. The upstream problem must be tackled: «The financing of the largest number of services envisaged by the nomenclature and the tariff, which goes from about 1,700 to 2,100, with an increase in costs estimated at over 400 million of Euro”.
In the agreement on the tariff decree reached in the State-Regions Conference, the coverage of the 400 million was guaranteed. The rather well-founded fear is that this money will not be enough and therefore the first effect of this lack, i.e. the lengthening of waiting lists, should not be opposed: «To absorb the lack of available resources in a given calendar year, the times in which the services are provided are lengthened, postponing those not covered financially to the following year». In other words, this is why when a citizen calls the CUP he hears the operator repeating that the lists or similar things are closed, forcing those who can to turn to the private regime and those who cannot to painful expectations or journeys of hope far from home. The problem therefore does not disappear, but in any case the importance of the step forward is recognised: «For certain categories of patients, especially those with even serious needs, there will be a benefit. For example, on the prosthetic side, patients will be able to receive technologically up-to-date aids free of charge. There will also be advances in diagnostics, rehabilitation, cancer treatments, and many other areas. Furthermore, the decrease in health mobility between a region that already includes these new services in its Lea and those that do not yet include them is foreseeable.
However, the nodes of our health system are not reduced to the Lea: «Compared to other Western countries, we have reduced health funding in terms of relations with the GDP and many problems undoubtedly depend on this aspect. But there is also the big issue of healthcare personnelwhich concerns both the numbers and the average age of doctors and nurses, also in this case higher than in the rest of Europe, and the composition of the profiles that will be most in demand in the coming years, due to the aging of the population and of the investments in district assistance, i.e. non-hospital, envisaged by the Pnrr», concludes Ricci.
Photo in opening: valelopardo from Pixabay