Healthcare, stop on tariffs: chaos over new free NHS care now back in the balance

There is no peace for the new Essential Levels of Care (Livelli essenziali di assistenza - Lea), which Italians have been waiting for eight years. Since 30 December, new treatments have officially been available to citizens at the expense of the Health Service and therefore free of charge or against payment of a co-payment: from medically assisted procreation to new cancer therapies. But after such a long wait, the new SSN services are back in the balance because the Lazio Regional Administrative Court of Law decided on the same day to suspend the decree that not only added the new Lea but also updated 1,113 tariffs associated with outpatient specialist services (in practice, visits and examinations) and prosthetic services out of the 3,171 that make up the nomenclator.

This new twist throws into chaos - the platforms of the ASLs already use the new codes - a game on which the Ministry of Health has been working for about two years and which has raised protests in recent weeks from laboratories and private facilities working with the SSN, which denounce a cut in reimbursements 'of up to 70%, both for public hospitals and accredited private centres,' FederAnisap, Uap and Aiop warn in a note. The Lazio Regional Administrative Court of Law has in fact decided to grant the precautionary petition filed by the trade associations - which yesterday spoke of a 'great victory' - thus suspending the Health and Mef decree of 26 November - published in the Gazzetta on 27 December - for the part relating to the new rates for examinations and outpatient visits (not, therefore, on prosthetics).

The Court granted the associations' request since the new decree 'was adopted more than 20 years after the previous nomenclators, thus outlining the lack of urgency'. On 28 January, a collegial hearing was scheduled for the council chamber. But the Ministry of Health, which had already had to digest two postponements under pressure from the Regions - the Lea and the new tariffs were expected as early as 1 January 2024, then postponed to April and finally to 30 December - does not want to give up and is currently working on an urgent appeal to the Council of State that could already 'save' the nomenclator and the new services pending the decision on the merits on 28 January, after which the Ministry could then surgically intervene with its decree. Also because there would already be 300-400,000 prescriptions issued yesterday through Sogei with the codes envisaged in the new price list.

The fact remains that the Lazio Regional Administrative Court's decision could once again postpone the entry into force of the new Essential Levels, which are due to start in 2017. This is a package of new treatments for which more than 500 million euros have been allocated: they range from assisted procreation to new aids and prostheses (such as digital hearing aids and domotic equipment), from new neonatal screening to the diagnosis and monitoring of celiac disease, endometriosis, and various rare diseases. Then there are innovative diagnostic technologies such as optical computed tomography to detect serious eye diseases such as retinopathy, glaucoma and maculopathy, which have become very common with the ageing population, or video capsules (enteroscopy with an ingestible micro-camera) to detect intestinal diseases. For tumours, stereotactic radiotherapy, Hadrontherapy (for certain inoperable tumour types) or radiotherapy with a robotic arm are also planned.