The NHS’s new free treatments can finally be provided under the new fee structure
Resources and cost awareness must go hand in hand with institutional convergence capable of ensuring continuity in the updating of services and tariffs
The publication in the Official Gazette on 30 September 2026 of the decrees updating the Essential Levels of Care expands the services guaranteed by the National Health Service. The main change, however, is the resolution of one of the system’s weaknesses: the time lag between the introduction of new Essential Levels of Care (LEA) and the approval of the corresponding tariffs.
The definition of the Essential Levels of Care (LEA) had been assigned to the National Health Plan by Legislative Decree 502/1992, as amended by Legislative Decree 229/1999. This procedure was never adopted: the preliminary investigation and assessment required for the updating decrees are carried out by a commission within the Ministry of Health. The LEA were first defined by the Prime Minister’s Decree of 29 November 2001 and updated, sixteen years later, by the Prime Minister’s Decree of 12 January 2017, across the three broad areas of collective prevention and public health, district healthcare and hospital care.
However, in order to make the new services available across all regions, it was necessary to await the tariff decree of November 2024, which comes into force in 2025. An initial tariff schedule had been approved by the Ministerial Decree of 23 June 2023 and was due to come into effect from January 2024. Two postponements – the first due to regional operational requirements, and the second to revise part of the tariffs at the request of the regions and service providers – further delayed the implementation of the 2017 Essential Levels of Care (LEA) and access to the new services. The revision resulted in an additional cost of 147.3 million euros.
The expansion of the LEA package thus came some eight years after the 2017 Prime Ministerial Decree (dPCM), with an update to the rates, some of which had remained unchanged since 1996. The Prime Ministerial Decree of 7 August 2026, on the other hand, was approved in conjunction with the revision of the rates for 448 services, out of a total of over 3,100. This has thus overcome the separation between the recognition of services and the determination of their remuneration.
This step is subject to two conditions. The first is the availability of the resources provided for in the budget laws for the updating of the Essential Levels of Care (LEA): 200 plus 200 plus 50 million euros. However, financial provision had also been made for the 2017 Prime Ministerial Decree (dPCM), and this alone had not been sufficient. The second condition is the setting of tariffs based on a survey of the costs of providing the services, deemed appropriate by the National Tariff Commission and the regional service providers.
