Waiting lists: even private individuals to cut queues, single cups and weekend services

If the treatment is not provided on time (within 72 hours for the most urgent up to 120 days for those that can be scheduled), the ASLs will have to guarantee the citizen a sort of passepartout "cut the queue" by ensuring the service in intramoenia (the free profession in the hospital) or through the accredited private sector with agreed rates. This is perhaps the most important measure for the citizen contained in the plan to cut waiting lists on which the Minister of Health Orazio Schillaci has been working and on which the premier Giorgia Meloni wants to play the last remnant of her electoral campaign.

The plan has been in the throes of a month-long tug-of-war with the MEF, which has put up a wall over the available resources, so much so that the landing in the Council of Ministers will come through a unbundling: a seven-article decree - this is where the 'row-cutting' measure is at stake - and, this is the novelty, a 14-article bill to be approved over a longer period of time with the measures for which the coverage will have to be found (from the defiscalisation of overtime to bonuses and sanctions for hospital managers). 'We want that if a citizen has to have an examination, a CT scan, for example, within 72 hours, he or she should have it paid for by the health service. that would be truly epoch-making,' Schillaci stressed yesterday. While the regions with the coordinator of the health councillors Raffaele Donini protested: "We have not been involved, let's start working together on the measures". The last knots will be untied with the first go-ahead for this package of measures, starting with the 'voucher', which, according to Health technicians' estimates, could have an impact of more than one billion: Schillaci aims to include it immediately in the mini-DL, also because a ministerial decree will in any case define the modalities within 60 days.

The decree law also envisages that visits and examinations can also be conducted on Saturdays and Sundays, and other measures (these at zero cost) are also introduced, starting with the activation of the national platform at Agenas to monitor the waiting lists on a performance-by-performance basis in real time. An Inspectorate is also to be set up at the Ministry of Health, which will monitor the correctness of list management, indicating possible sanctions, and its staff will have 'administrative and judicial police functions', with the possibility of making use of the Guardia di Finanza and Nas. There will be an obligation to create a single regional or infra-regional Cup 'with all the services available' from the public and private sector (which is only partially the case today). Private individuals who fail to do so will have their contracts cancelled, while it becomes a requirement for accreditation for those who do not yet have it. Also in the decree, in addition to stricter checks on the abuse of intramoenia by doctors, which must not 'exceed the ordinary activity', there should also be - but here too there are the latest intelocutions with the Ministry of the Economy and Finance - the overcoming of the spending ceiling on the recruitment of doctors and nurses: in 2024 it will grow by 15% of the increase in the Health Fund, while from 2025 it will be replaced by the standard requirements. The expenditure ceilings for the purchase of services from private contracted providers will be adjusted (Mef permitting), after the increases already envisaged by the last manoeuvre.

On the other hand, the bill will include the measures on which cover will have to be found more calmly, given the longer time required to pass a law in Parliament: in particular, these are the interventions on personnel, such as the flat tax at 15% on staff overtime (today, taxes for doctors are 43%) or the increase in the hourly rate (100 euro) for outpatient specialists up to the assignments (10 hours a week) for trainees. Also in the bill will be bonuses (a 10 per cent increase in result remuneration) and sanctions (up to the revocation of the appointment) for managers of health companies in the management of waiting lists, but also measures to cut unnecessary prescriptions for visits and examinations that flood the National Health Service.