Decentralised healthcare: Gimbe: ‘essential care at risk’
According to the Foundation, the significant differences between Lombardy, Veneto, Piedmont and Liguria in terms of waiting lists, healthcare mobility and staffing are likely to increase, thereby exacerbating inequalities and leading to greater reliance on the private sector
Key points
From compliance with the Essential Levels of Care (LEA) – that is, the care that the National Health Service is required to provide free of charge or subject to a co-payment to all citizens – to healthcare mobility, which leads to attracting or ‘losing’ patients. From the percentage of citizens who forgo healthcare services, partly due to waiting lists, to the significant differences in staffing levels, starting with GPs and nurses. The four regions seeking differentiated autonomy in healthcare – Lombardy, Veneto, Piedmont and Liguria – show profound differences, which the ‘greater powers’ envisaged by the reform would risk exacerbating, ‘increasing inequalities in access and privatisation’. This was highlighted by the Gimbe Foundation during the hearing before the Senate Constitutional Affairs Committee on the draft agreements for differentiated autonomy.
Fairness at risk
“The powers sought by the regions – differentiated regional tariffs, autonomous management of state resources for healthcare construction and technology, the establishment of regional supplementary health funds, greater scope for staff recruitment and additional services, and the reallocation of earmarked national resources – could have significant effects on the equity and uniformity of the National Health Service,” the Foundation points out.
“The problem,” said Gimbe president Nino Cartabellotta, “is not administrative autonomy in itself, but the context in which it is intended to be applied. Transferring further health responsibilities to regions that already start from very different conditions means intervening in a National Health Service characterised by underfunding, persistent difficulties in guaranteeing Essential Levels of Care (LEA), and growing reliance on private spending. In this scenario, the very powers being requested can produce very different outcomes depending on the organisational, administrative and financial capacity of individual regions: without adequate safeguards and equalisation mechanisms, there is a risk that differentiated autonomy will further strengthen those who are already stronger and make it even more difficult to bridge existing gaps,” he explained further.
‘After all, the Constitutional Court itself has made it clear in judgments 192/2024 and 10/2025 that differentiated autonomy requires a rigorous assessment, function by function, and adequate safeguards to ensure uniformity of rights across the whole country. In the absence of these conditions, the risk is not only of widening inequalities in access to care, but also of legitimising them,” continued Cartabellotta.
Waiting for the Lep
“For this reason, the Gimbe Foundation has called for the process to be suspended or made subject to a moratorium ‘until the regional health plans have been finalised, the associated standard costs have been quantified, and a national system has been adopted to monitor the impact of greater regional autonomy on health, access and equity’,” Cartabellotta proposed at the end of the hearing.
