Healthcare, waiting lists: from queue-jump to ticket for no-shows, here are the changes for patients

First and foremost, there is the guarantee - on paper for the time being, however - that every service will be provided on time, thanks to the new queue-jumping mechanism: if at the time of booking there is no room for an examination or CT scan in the hospital, then the local health authority must ensure that the same service is provided to the citizen on time - free of charge or against payment of a fee - in an accredited private facility or in the hospital, but using intramoenia, i.e. the free profession of doctors within the facility. This is the symbolic measure of the plan against waiting lists launched by the government, which, however, also envisages duties for the citizen, starting with the fact that if he does not turn up for the appointment for the examination or test, he will still have to pay the co-pay fee.

Explaining the new queue-skipping measure was the Health Minister Orazio Schillaci himself, assuring that for citizens 'dissatisfied' with waiting to be treated, the Asl 'will have to guarantee' the same service from accredited private providers at agreed rates or in intramoenia (the free profession of doctors in the same hospital), with the citizen only having to pay the co-pay (if not exempt). "If a patient has to get an MRI within 72 hours he will get it where it is possible and the SSN will pay for it," confirms Schillaci. Today, services in the health service are in fact provided on the basis of classes of priority with well-defined times according to the indications of the prescribing doctor, who must indicate this on the prescription: in class U (Urgent) within 72 hours of the request for the service; in class B (Short Waiting) within 10 days of the booking; in class D (Deferred): within 30 days for examinations or 60 days for diagnostic tests from the booking; finally in class P (Programmable) within 120 days of the booking.

But when will this 'queue-jumping' mechanism be operational and how will it be financed, which recalls a hitherto unenforced (Law 124/1998) but less binding rule that provided for reimbursement for those who went to the private sector in the event of an excessively long list? The draft decree envisages, first of all, that it will be an implementing provision to be defined with the Regions that will define the modalities and details within 60 days, but in the meantime the same decree does not add any new resources to finance it, drawing on two paragraphs of the last manoeuvre that envisages being able to use 0.4% of the NHS funding (over 500 million) for waiting lists and increases by 123 million the ceiling for purchases from the private sector in 2024, 370 million in 2025 and almost 500 million from 2026. Will this be enough to meet the unsatisfied demand for care that convinces 3 million Italians not to seek treatment because of excessively long waiting lists? We will see in the coming months, also because initial estimates suggest that the measure will cost over a billion a year.

Another measure envisaged by the decree approved by the government, namely the obligation to have a single regional or infra-regional Cup (the Reservation Centre) with all the services available from the public and private sector, will also reduce the citizen's waiting time, and foresee the nullity of the contract with accredited private companies that do not include their services in the public Cup.

The prohibition for health authorities and hospitals to suspend or close booking activities and agendas is also reiterated. Regions are then encouraged to adopt digital solutions to facilitate the independent booking of examinations and payment of the ticket. And a series of indications are given, including that of guaranteeing a recall system for citizens to avoid the phenomenon of services booked and not carried out (estimated at 20% of cases). There are also rules to be respected for citizens: those who do not carry out the booked visit or examination without prior notice - except in cases of force majeure and supervening impossibility - will still have to pay the co-pay fee: those who refuse an examination must give others the opportunity to take advantage of the service. Lastly, again to make things easier for citizens for hospitals and outpatient facilities, there will be the possibility of visits and diagnostic examinations also on Saturdays and Sundays, extending the time slot.