From severance pay for 700,000 workers to service charges: the key healthcare issues coming to a head in the budget

As has been the tradition for decades, after the summer the Government begins to consider the measures to be included in the Budget Bill, which this year, as is well known, will be a particularly sensitive one as it is the last of the parliamentary term. For weeks now, rumours and speculation have been swirling regarding its possible contents: energy cost containment, income tax relief, windfall profits, pensions, vehicle tax, flat tax and so on. Within the ruling coalition, there are already those who envisage a budget totalling over 30 billion euros; some are even suggesting 40 billion, given the looming election campaign. For his part, the Health Minister is reported to have requested 5 billion euros for staff recruitment, medicines, care for the elderly, chronic conditions and the completion of facilities linked to the National Recovery and Resilience Plan (PNRR).

Nevertheless, when it comes to making final decisions, the Government will have no choice but to take into account certain financial issues that are placing a burden of tens of billions on the public health service. These are long-standing issues and disputes that have never been tackled with the necessary determination, but which could escalate to an unsustainable level in the medium term. Let us see what these are.

First of all, many disputes have been ongoing for years and, due to the constant and total lack of decision-making, the associated costs are rising exponentially. The issues are well known: meal vouchers for shift workers, payment in lieu of unused holiday leave, and pay due during holiday leave. The recent sectoral preliminary agreement of 29 July and Decree-Law 144/2026 of 4 August have laid down certain provisions on the two issues relating to annual leave, but these measures will apply exclusively to the future, whilst the entire backlog looms large with enormous costs, given that the limitation period for the amounts to be reimbursed is ten years rather than five. As regards meal vouchers, the situation is even worse because the National Collective Labour Agreement has once again postponed a solution entirely, as shockingly admitted in Joint Declaration No. 2.

But that is not all, because there are two further non-contractual issues for which a date has already been set as a strict deadline. The first is the matter of the payment schedule for severance pay (TFR) to public sector employees, which obviously includes the 700,000 workers in the public health service. After years of unresolved disputes, the Constitutional Court, in Order No. 25 of 5 March 2026, has once again urged the Government and Parliament to review the regulations introduced in 2010. This time, however, the Court has set a specific deadline: if the current regulations are not amended by 14 January 2027 to bring them back within the bounds of legality, the Court could declare the existing rules unconstitutional. Such a decision would have significant consequences for public finances and, according to INPS estimates, the immediate impact would amount to over 15 billion euros. The ruling is therefore an interim one and has granted the ordinary legislature a one-year moratorium to address the glaring constitutional irregularities identified in the payment timelines. However, if, in four months’ time, no progress has been made beyond the derisory measures introduced by the 2026 Budget Act (paragraph 198), the Constitutional Court will be forced to proceed.

The other major financial burden stems from the process of revising the tariffs for the Essential Levels of Care (LEA), that is, the services which the public health service is required to provide to all citizens: the decree of the Minister of Health of 25 November 2024 was annulled by three judgements of the Lazio Regional Administrative Court (Third-Quarter Section, judgements nos. 16399, 16400 and 16402 of 22 September 2025), following appeals by over 350 accredited private healthcare facilities. The judges had specifically contested the use of cost data deemed ‘out of date as they related exclusively to the years 2015/2016’ and an investigation deemed insufficient regarding certain items, including initial consultations. However, the administrative judges ordered the annulment to take effect one year after the filing of the appeal, meaning the Government must take action by 22 September this year.