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Waiting lists in healthcare, reducing them is necessary but it is unacceptable to compress the time for treatment

A visit cannot be a Formula 1 'pit stop': the quality of care also depends on the possibility of investigating, explaining, and preventing errors and inappropriateness, while freelance practice makes it possible to avoid 'pure private practice'

by Guido Quici *

11 May 2026

3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

Waiting lists have become the political thermometer of Italian healthcare. New regulations have been adopted and it seems that concrete results are being achieved. The message reaching citizens is reassuring: the system is recovering efficiency. But inside hospitals the climate is very different, and the question doctors and operators are asking themselves is simple: are we really treating patients better or are we just speeding up the assembly line?

More care in the same time

In recent months, the dominant theme in several Italian healthcare companies has not been staff increases or the structural strengthening of services, but the need to provide more services at the same time. An increasing pressure that, in many cases, translates into a reduction in the time to visit and an intensification of work rhythms.

It is here that the paradox of the Italian public health service is being played out: the reduction in waiting lists is being celebrated while professionals complain that they have less and less time to adequately attend to patients. And yet a visit cannot be a Formula 1 pit stop: the quality of care also depends on the possibility of investigating, explaining, and preventing errors and inappropriateness.

Attachment to freelance

In the meantime, an ideological battle continues against intramoenia, which for years has been treated as an absolute evil, despite the fact that it is often one of the few ways that allows the public system to recover services that would otherwise end up completely in the purely private sector, and for doctors to really take care of patients, earning - it should be remembered - only 30% of the fee paid by the patient: the rest goes on various items, including a company fund to be used precisely for the reduction of waiting lists.

regional 'recipes'

In Sicily, for example, the ratio between free-professional and institutional activity is calculated by taking into account only outpatient activity and not overall activity, transforming a criterion of balance into a bureaucratic noose that unreasonably restricts the professional autonomy of doctors.

At the Galliera in Genoa, they are even attempting a little creative masterpiece: offloading onto the costs of intramoenia a share of the exclusive indemnity, which, however, has nothing to do with freelance work, since it is already financed by the State. A sort of roundabout game where, in the end, it is always the same people who are likely to pay: the citizens.

In Umbria, on the other hand, extended intramoenia, i.e. the activity carried out in contracted external practices, has been blocked, creating inefficiencies and problems even for patients who had already booked. And yet there is already a regional rule that would allow companies to offer intramoenia services at reduced rates for those citizens who, because of waiting lists, are unable to access the National Health Service on time. But evidently it is easier to block than to organise.

It is no better in Trentino, where 700 thousand euro have been allocated to allow patients to perform intramoenia services by paying only the ticket. It is a pity that the mechanism continues to get jammed up between cumbersome administrative procedures and the chronic shortage of nursing staff. The funds are there, the instruments too, but the machine remains at a standstill in the pits.

The NHS crisis

The fight against waiting lists cannot become a race to see the most patients in the shortest time, sacrificing safety of care and professional autonomy. And instead of demonising intramoenia, it would be more useful to use it well, because it can be part of the solution and not the problem.

The truth is that the issue of waiting lists is often addressed as an emergency rather than as a symptom of a deeper crisis in the National Health Service. There is a shortage of doctors, a shortage of nurses, a lack of a territorial network capable of filtering health demand, and above all a lack of serious reflection on the appropriateness of diagnostic and specialist requests.

Continuing to chase only numbers risks giving the impression of a faster system while progressively impoverishing the quality of care. Indeed, healthcare is not measured only by counting how many visits are made.

Reducing waiting lists is necessary. Doing so by compressing treatment times, however, risks having a much higher cost than one is willing to admit.

* President CIMO-FESMED Federation