The Calderoli bill will lead to a more autonomous but united Italy. However, after the approval of the Calderoli bill, which passed its first reading in the Senate on January 23, there are many fears that differentiated autonomy could generate disparities among Italians simply because they reside in one place rather than another.
«I think the Government is also aware that the risks of inequality can occur», he explains Maurizio Motta, contract professor at the Faculty of Political Sciences of the University of Turin, former manager of the social services of the Municipality of Turin and collaborator of the Institute for Social Research, «in fact he defines the essential levels of Lep benefits as a regulatory framework that ensures a minimum level of interventions in each region. A corrective to the possibility of generating disparities.”
Professor Motta, how can we be sure that defining the Essential Performance Levels will avoid inequalities?
Difficult to predict. But we can begin to see the limits of the current essential levels of LEA assistance, which already exist, to understand which aspects to improve. First of all, the language with which they are described should be changed. There are well-defined essential interventions, such as the provision of prosthetics or the care of newborns within the first month of life. While others do not explain enough or are open to any interpretation. An example is home care aimed at non-self-sufficient people which must be, as we read in the text: “integrated with social interventions”: that’s saying everything and nothing. Furthermore, the Lea should be enforceable rights, perhaps minimal but still usable. Instead we can all see that the real feasibility of the interventions described in the LEAs is greatly weakened not only because the National Health Service has insufficient resources but also because the LEAs are expected to be subordinated to the available resources of the bodies that manage them (this is foreseen by the art. 1 of Legislative Decree 229/1999). This means that they become financially conditioned rights, therefore with a completely uncertain enforceability.
What are the consequences of financially conditional rights?
For example, there are regions in which non-self-sufficient people hospitalized in assisted health residences have to pay the entire cost of the fee, around 90 euros per day, because their local health authorities do not pay 50% which, instead, must be paid by them in based on the Lea in force. Or there are regions in which home care for serious non-self-sufficient people consists of a maximum of 3 hours per week from a social-health operator. In others, however, the family can choose between a mix of interventions connected to a significant treatment budget. Obvious disparities.
Are there other critical issues that should be avoided in future Leps?
You should be able to update them frequently. The LEAs must also be revised due to the evolution of needs, intervention capabilities and resources: yet after being issued in 2001 they only received the first update in 2017. It is essential to prepare a device that allows for more adequate revisions to changes of the conditions of reality. Not to mention the monitoring system of the Ministry of Health which annually checks whether the individual regions comply with the implementation of the LEAs: on various issues there are no adequate indicators. For example, to verify the level of home interventions for non-self-sufficient people, or to evaluate whether local healthcare avoids inappropriate hospital admissions.
So returning to the initial reflection, can we say that in order to have Leps capable of correcting the risk of inequalities, it is important to keep in mind what is imperfect we have already found in the Leas?
Yes. And I would add that to reduce inappropriate differences between territories it is important to look at the methods for planning the distribution of state financial resources. This means going beyond funding based on historical spending and defining how regional needs are identified and monitored over time. It is not enough to provide that state funding is paid to the regions only on the basis of the “standard costs” of the essential services to be guaranteed. The system should both define the standard costs of the benefits and services to be guaranteed everywhere, therefore the essential levels, and evaluate the differences in the “needs” of each region, i.e. monitor where risks and situations of deprivation require more adequate resources.
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