In certain areas of Italy the right to health is dented. Waiting times for some visits and tests constantly exceed the limits prescribed in medical prescriptions. Furthermore, in some hospitals it happens, strangely, that the number of paid visits (intramoenia) is higher than those provided under the public regime. Let me be clear, not all is bad. To say so would be an exaggeration. The fact is however that, in recent weeks, Active citizenship, mobilized for some months on this decisive issue, has carried out a survey on waiting times for six different types of specialist visits and diagnostic tests in 12 large local health authorities – Asl of four Regions. The types concern: cardiological, gynecological, pulmonary, oncological, abdominal ultrasound and mammography examinations. The findings suggest necessary interventions and adjustments.
According to the survey, the Puglia presents very negative data for compliance with the waiting times envisaged by the national government plan. For example, in the Local Health Authority of Lecce no priority D pulmonary visit is guaranteed within the 30 days envisaged; in the ASL of Bari only 9.38% of gynecological visits with priority B and 14.39% of complete ultrasounds of the abdomen, always with priority B, are guaranteed within the envisaged ten days. The situation improves slightly in the ASL of Taranto, where waiting times are respected at least in 33% of cases, but even here negative peaks can be recorded. For example, for a priority B pulmonary examination, for which the times are respected only in 20.83% of cases.
Also in Liguria the situation is not the best, with a series of very important negative peaks recorded in the various ASLs examined: the Cittadinanzattiva survey shows that for a cardiological visit, always with priority D, i.e. to be carried out within 30 days, in the Asl Ligurian 1 Imperia there are waiting times of 159 days; for a P-priority mammography (to be carried out within 120 days), in the As Ligure 5 Spezzino you even have to wait 253 days; for a complete abdominal ultrasound with priority D (within 60 days), in AS Ligure 3 – Metropolitan area of Genova there are even waiting times of 270 days, almost five times higher than those required by law.
The situation in Emilia Romagna is definitely better, even if i available data are only aggregated and not distinguished by priority code, which does not allow for a well thought-out analysis. Many positive situations can be found in the Local Health Authorities examined but, also in this case, the research highlights the negative peak for the pneumological visit in the Local Health Authority of Reggio Emiliawhere deadlines are respected only in 39% of cases, or in the Ausl di Bolognawhere waiting times for cardiological visits are respected in 57% of cases.
In some situations, the intramoenia, together with the emergency room, has become the main gateway for citizens to the National Health Serviceslowed down by too long waiting times
—Anna Lisa Mandorino
Also in the Lazio the situation is quite positive, with some criticalities: for a complete abdominal ultrasound with priority B (to be performed within 10 days), in the ASL Roma 4 waiting times are respected only in 18.2% of cases; for a cardiological visit with priority D (within 60 days), in the ASL of Viterbo waiting times were observed in 47.2% of cases. Better situation in ASL Roma 1, where there are however criticalities for the pulmonary examination and complete abdominal ultrasound, both with priority P (within 120 days), where times are respected in 61.6% and 58.6% of cases.
Also in recent weeks, Cittadinanzattiva has also launched a application for civic access in the regions to get to know i data relating to healthcare services provided in the public system and intramoenia (term that refers to paid visits provided within public structures), and check any measures implemented by the administrations where the limit set by the National Government Plan of waiting lists has been exceeded in the relationship between the two activities. The detailed report of the request will be announced in the coming weeks. Particularly alarming is the picture of the Campania, where the Region itself reports that the number of services provided in the public channel is lower, for all exams and monitored visits, than those provided intramoenia, and this is true for all hospitals. Here are some particularly bad data in 2022: at the hospital Cardarelli in Naples, 1255 orthopedic visits were administered intramoenia and 112 in the public; at the Colli hospital, always at Napoli, no abdominal echo was administered in public, 111 were done intramoenia; at the Moscati hospital in Avellino seven public cardiological visits and 979 in the intramoenia regimen were administered; to the Saint John of God e Ruggi D’Aragona a Salerno91 obstetric ultrasound scans were performed in the public channel and 329 in intramoenia.
«In some situations the intramoenia, together with the emergency room, has paradoxically become the main gateway for citizens to the National Health Service, slowed down by too long waiting times. We are therefore faced with a distorted use of what should be a possibility of choice for the citizen, and not a necessity. While waiting lists remain an emergency that must be tackled urgently to reaffirm citizens’ right to public health,” he says. Anna Lisa Mandorinogeneral secretary of Cittadinanzattiva.
How to concretely improve the situation? «Through an investment in human and technical resources and a consequent extension of the opening hours of the clinics to the public, as well as through the networking of the agendas of the Single Booking Centers – Cup of all the public and private healthcare facilities with which better scheduling and transparency of waiting times. Not at least by blocking, at regional level, intramoenia services where these exceed those provided in the public channel in terms of number, as envisaged by the same National Government Plan for waiting lists», specifies Mandorino, who also opens up the issue of unused resources, recalling that still a third of the 500 million euros made available by the central level for the recovery of unused services disbursed due to the pandemic, have not been used by the regions: «It is about 165 million that risk being wasted. The latest public monitoring tells us that the Molise it invested only 1.7% of what it had available, around 2.5 million; Sardinia is also bad (26%), the Sicily (28%), the Calabria and the province of Bozen (29%)».
In recent weeks, Cittadinanzattiva has launched a permanent mobilization campaign entitled “Health Urgency” and a related petition on Change.org to ask for the waiting lists to be overcome. The survey summarized in this article is available on the association’s website.