Healthcare, Lombardy cold in the face of the Schillaci reform

Within a health sector in search of new budgetary balances, the (possible) reform cast from above by Health Minister Orazio Schillaci creates even more dissent in Lombardy. And not even the centre-left opposition is needed to criticise it: it is the centre-right majority, the same as the minister, that does not appreciate the direction indicated by a bill that still has to be defined in detail.

Officially, the department does not take a position. Asked about the issue, Guido Bertolaso does not reply. However, Lombardy's leaders do not say they are happy for two main reasons: the first is methodological, because the regions were not consulted, especially Lombardy, which has 10 million inhabitants (and expresses a healthcare system with many excellent features); the second is merit-related, because the project would provide for the creation of large third-level national hospitals, probably controlled by Rome and no longer by the regions. It is not clear what this step would consist of, but in any case it could be a new form of centralisation, which is the opposite of what Lombardy is calling for, where for years the administration led by Attilio Fontana has been arguing for greater autonomy. In Lombardy, therefore, the contradictions of a government majority that has two opposing tendencies become plastic: federalism and the new centrality of the state.

The heart of the national measure, still in its embryonic phase, is the integration of hospital and territory, also through the updating of standards of care. An important part concerns the revision of the classification of hospital facilities: in addition to basic, first and second level hospitals, the reform introduces two new categories.

There will therefore be third level hospitals, that is, facilities of excellence with a national or supranational basin, including those managed by private non-profit or religious entities, to be financed with dedicated resources on the basis of homogeneous criteria. These hospitals will be identified according to homogeneous criteria and requirements at a national level, which are very stringent, from the quantity of admissions to the casuistry treated by the facility, from quality standards to the share of patients coming from other regions, from the research activity carried out to technology transfer and operator training.

The initiative would seem to be aimed at public IRCCSs - i.e. the Institutes of hospitalisation and care of a scientific nature, which combine clinical activities and medical research - but also at hospitals of national importance and high specialisation, or public facilities that represent the most advanced centres of the National Health System. The Policlinico and Niguarda could therefore be included in Lombardy, but when there are detailed laws, the picture will be clearer.