Gimbe: Equalising Lea and Lep shortcut to speed up regional autonomy

"The Essential Levels of Benefits (LEP) do not coincide with the Essential Levels of Assistance (LEA), neither on a normative nor on a substantive level. The Government's decision to equate them, forcing the interpretation of a Constitutional Court ruling, has the clear aim of accelerating the implementation of differentiated autonomy, which is destined to be even more of a multiplier of inequalities". This was said by the president of the Gimbe Foundation, Nino Cartabellotta, during a hearing at the Senate's Constitutional Affairs Committee, as part of the examination of draft delegated law no. 1623 for the determination of the Lep. "The healthcare LEPs," he added, "must be defined on a par with all other matters so as not to crystallise by law regional differences that are already unacceptable today, further weakening the regions of southern Italy and burdening those in the north with excessive healthcare mobility.

The LEP are the set of benefits and services that the State must guarantee in a uniform manner throughout the national territory, to ensure the fundamental civil and social rights of persons regardless of the region or municipality of residence. They are provided for in Article 117 of the Constitution, which gives the State exclusive competence in determining them, although many functions are performed by Regions and local authorities. The LEP cover all civil and social rights, for example: social services, education, health protection, local public transport, housing policies, and services for social and labour inclusion. To date, these levels have not been defined except partially and only in some areas.

In health care, any discussion on the LEP cannot disregard an assessment of the current regional inequalities in the provision of the LEP, i.e. the services and facilities that the National Health Service (NHS) is required to provide to all citizens, either free of charge or against payment of a co-payment. The official monitoring of the Ministry of Health through the indicators of the New Guarantee System (NSG) shows deep differences between the regions. In 2023 (the last year available) as many as eight regions are found to be non-compliant with the NSG by failing to reach the minimum threshold of 60 out of 100 points in at least one of the three macro-areas: prevention, district and hospital. "Taking into account that the NSG only provides a general picture on the fulfilment of the LEAs," Cartabellotta pointed out, "but does not measure the actual quality of the assistance provided, let alone the actual enforceability of the constitutional right to health protection, the extent of regional and territorial inequalities is largely underestimated.

DdL 1623 is a fundamental step for the implementation of differentiated autonomy. In his speech, Cartabellotta recalled how, already during the legislative process of the reform, the Gimbe Foundation had requested to expunge the protection of health from the list of matters that can be transferred to the Regions, because it is destined to legitimise the normative gaps between North and South, concretising an unacceptable violation of the constitutional principle of equality of citizens in exercising the right to health protection.

DdL 1623 proposes to exclude the protection of health from the subjects for which the LEPs are to be determined, arguing - on the basis of Constitutional Court sentence no. 192/2024 - that in healthcare the LEAs already perform this function. "In sentence no. 192/2024," Cartabellotta explained, "the reference to the LEAs is merely illustrative in nature, but it does not formally equate the healthcare LEPs with the LEAs, nor does it overcome the terminological distinction between the two concepts, because to do so would mean confusing the constitutional principle enshrined in the LEPs with the operational tool represented by the LEAs.