Public or private? The rules for 'accrediting' healthcare facilities
Out of approximately 30,000 facilities, 58% have an agreement with the SSN: residential care (85.1%), rehabilitation (78.4%) and outpatient specialisation (59.7%) stand out
Key points
The issue of the relationship between the public and private sectors in healthcare has always been very hot and divisive. According to many observers, a 'creeping privatisation' of Italian healthcare is underway, which some understand as an increased use of paid services and others as a more intrusive presence of the accredited private sector in the provision of healthcare services.
Accreditation tenders postponed
Although out of time, the annual law for the market and competition 2023 was approved, which in Article 36 suspends until 31 December 2026 the contested new regulations for the accreditation and conclusion of contracts with the National Health Service of private facilities, introduced by the Draghi government (Art. 15 Law 118/22).
That rule provided for the regions to put out to tender, periodically, the provision of new services and those already accredited, according to their own needs for planning and rationalisation of the network. It will be the State-Regions Conference that will review the matter of accreditation by the set date.
The two trade associations (the Aiop for for-profit hospitals and the Aris for religious hospitals) had even asked for the article to be repealed, arguing that the Bolkestein directive explicitly excluded healthcare services from its scope of application (Article 2f directive 2006/123). Currently, the agreements between the SSN and private individuals are, in fact, open-ended.
Public and private healthcare in the health service
The entanglements between public and private healthcare are numerous, solid and long-standing. They date back at least to the 1940s and 1950s. The SSN, established in 1978, in fact implemented the system of 'conventioning' with the private sector (Art. 25 Law 833/78) established in 1943 by the Inam - the largest mutualist organisation - and in its first year of existence extended its services to all citizens (Law 33/80). The Inam only had its own specialist outpatient clinics (857 in 1978, which have now become, in some cases, community homes) and for everything else it relied on contracts with public hospital bodies or private companies (nursing homes, laboratories) and freelance professionals (general practitioners and specialists).
