The 2027 Budget, from holiday entitlement to severance pay: the variables affecting the public health sector

In the draft budget bill for the 2027 budget, the public healthcare sector comes off rather badly, as it has for far too many years. I have written ‘public’ because, all things considered, the private healthcare sector does secure some measures that are certainly very welcome (the redefinition of tariffs for accredited private facilities, the €300 voucher, and the reduction in co-payments for both medicines and medical devices), again in line with recent trends. The arguments over how much the National Health Fund has increased in absolute terms or as a proportion of GDP are entirely pointless and frustrating; what matters is that the Health Minister is satisfied because the Fund has reached 146.3 billion euros and because there have been no ‘cuts’.
On the other hand, a statement by a regional president appears both worrying and significant; he declared, despondently, that healthcare is thus a function which the central government can take back. The terms of the debate over recent months are well known: the Health Minister requested €5.5 billion for the Health Fund, but received only €2.4 billion, whilst the regions’ requests, in any case, amounted to €7–8 billion. The most striking aspect of the budget is the allocation of 138 million euros to be ‘at the regions’ discretion’ – little more than ‘pocket money’.

Among the few items of expenditure that have been taken into account and the many that have not been recognised, experts have drawn conflicting conclusions regarding whether the budget is adequate or underfunded. Looking ahead, further scenarios are on the horizon which have not been taken into account but which will undoubtedly affect the already precarious financial balance of the National Health Service. Months ago, I wrote about certain financial variables, all arising from long-standing legal disputes. I shall attempt to revisit those issues to provide an update.

Last summer, an emergency decree was even issued regarding the monetisation of holiday entitlement, in an attempt to curb the widespread recognition of such claims by the courts. Nevertheless, the provisions of Decree-Law 144/2026 did not provide for any dedicated funding, meaning that the costs remain the responsibility of individual healthcare organisations. But there is more to it than that, because whilst the government’s intervention looked to the future, all past litigation remains unresolved; as with meal vouchers, this is subject to a ten-year limitation period, since these are not claims relating to remuneration but to compensation.

In this case, the two collective agreements – one for the sector (Article 28(2)) and the other for healthcare management (Article 18(2)) – have resorted to a workaround by introducing a holiday allowance that is intended to enable compliance with the principles laid down by EU case law. However, it must be said that the solution found in response to the growing number of disputes may not even be deemed sufficient by the labour courts to comply with the concept of ‘European pay’. At this stage, it remains only to add that the remedy introduced will take effect from 1 January next year, leaving previous disputes relating to the last five years unaffected; the limitation period should in fact be five years, as these are disputes concerning remuneration.

The sector’s National Collective Labour Agreement, the preliminary agreement for which was signed on 29 July, has completely sidestepped the issue (see Joint Statement No. 2), leaving healthcare organisations to face certain defeat in court. However, the Government has stepped in: under paragraph 5 of Article 69, it has allocated €100 million to cover the ‘costs arising from court judgements and settlement agreements’. The financial impact of the ongoing litigation is enormous, so much so that the Conference of Regions, in a document dated 10 September (No. 26/126/CU07/c1), estimated that costs already incurred due to enforceable or final judgements amount to €7,981,596.59, costs arising from settlement agreements already entered into amount to €32,134,059.56, potential liabilities arising from pending litigation amounting to €38,523,327.59, and potential liabilities arising from the general application of case-law principles amounting to €1,897,206,482.90.