Waiting lists, dark on funds: less than 30% spent in 2023

Thick darkness reigns over the actual use of the funds made available in recent years for the priority objective of reducing waiting lists in healthcare. And not even the few flashes of light that open up after a laborious search for data appear encouraging. This is explained by the Court of Auditors in the extensive report published yesterday by the central control section on the management of state administrations (resolution 90/2024, rapporteur Giampiero Pizziconi), which in 180 pages attempts a very complicated reconnaissance of the picture of waiting lists generated by Covid, resulting in two central findings: an overall monitoring is in fact still to be constructed, because the controls put in place so far have not worked, and on the 2023 funds that it has been possible to reconstruct the use is very partial, and often disconnected from the actual reduction in waiting lists. Because, in practice, in some cases the regions have used these resources to reduce deficits and close budgets.

The numbers, it was said, do not yet offer a complete census. But they speak clearly. In 2023, the regional operational plans for reducing the waiting lists created by the pandemic had two strands of funding available, generated by the allocations of the previous two years. On the first strand the availability was 483.87 million, but the actual spending stopped at 29.7 per cent (69.13 million). On the second, covered by the 0.3% restricted portion of the National Health Fund, there were 365.48 million and 171.23 million, or 46.9%, were used. However, the actual utilisation rate of this last strand, which is higher than the previous one, is not necessarily positive news for those who hope to wait less for an examination or a specialist visit: because it is precisely here, the accounting magistrates point out, that the 'alternative' uses are hidden, aimed at health budgets before patients, because 'the broader finality, normatively provided for' by Decree-Law 198/2022 could 'induce the Regions to use the resources as a priority to make good their health deficits and, only residually, to break down waiting lists'. In any case, the average of the two chapters leads to an actual expenditure of under 30% (239.4 million out of 803.4).

The issue is a serious one. Because the guarantee of not having to endure biblical waits to receive a health service is a crucial component of the essential levels of care, which several regulatory interventions have tried to armour, for example with the provision of an explicit ban on suspending booking activities introduced as early as the 2006 Financial Law (paragraph 282 of Law 266/2005). And because in order to make up for the delays accumulated during the pandemic emergency, the funds explicitly earmarked for this purpose have multiplied to reach 2.049 billion over the last five years, in an account that also includes the 500 million foreseen for this year according to a similar mechanism (tied share of the health fund) to the one that has allowed for different uses.

The result is summed up in effective terms by the Court itself, when it judges as 'self-evident' the fact that 'despite the not indifferent amount of resources made available, their utilisation appears meagre'. And in such a context a change of pace can only come from the development of effective and timely monitoring, which is at the heart of the nine recommendations addressed by the resolution to the Ministry of Health. Because the checks must extend across the board, ranging from the effective sanctioning of cases of interrupted bookings that have been prohibited for almost twenty years to the up-to-date situation of waiting lists, which cannot function without 'adopting an efficient information acquisition toolbox'. Otherwise, there is a real risk that even the 505 million put into the pot by the last manoeuvre will produce modest results.