Medical Association: if the citizen cannot find a place the SSN pays the bill from the private sector

Charging the National Health Service for services provided intramoenia, where citizens are obliged to use them not by choice, but because they cannot find a place in the public sector. Espousing this proposal - already envisaged in the law on waiting lists approved a year and a half ago, but hardly applied so far - is the President of Fnomceo, the National Federation of the Orders of Surgeons and Dentists, Filippo Anelli, after the Il Sole 24 Ore investigation that anticipates the first data, relating to 2025, of the national platform on services, activated at Agenas. "A maxi control centre for waiting times fed by the flow of data from the Regions coming from the Cups," reads the article, strongly desired by Health Minister Orazio Schillaci, which highlights delays and territorial inequalities, between Region and Region and between Asl and Asl.

It is precisely the free profession of physicians carried out within the structures, intramoenia, that is one of the indicators monitored: 'The first data,' we read in the survey on waiting lists published by Il Sole 24 Ore, 'show that it is precisely where there is the longest wait when knocking on the door of the health service that the wait is reduced to a few days if the patient puts his hand in his wallet. What to do then? Anelli is lapidary: 'If the responsibility lies with the system, the bill to citizens should be paid by the National Health Service,' he says. And that the responsibility lies with the system is underlined by the Corte dei Conti, the Parliamentary Budget Office, and the State General Accounting Office. "Italian citizens love their National Health Service," Anelli begins in the video of the new Fnomceo Tg Sanità - but they consider waiting lists the main problem of Italian healthcare. The Parliamentary Budget Office has long pointed out that one of the ills of our system is precisely that of organisational inappropriateness. What does this mean? It means that a shortage of doctors, a lack of instruments or facilities pushes citizens very often to forego treatment'.

'There are 6 million citizens, according to ISTAT,' he adds, 'who either forgo treatment or go private. Private expenditure has now risen to over 43-44 billion. So citizens today, faced with the denial of a visit or the biblical postponement of a service, prefer to go either private or intramoenia. What is intramoenia? Intramoenia is that free time made available to doctors to carry out a free profession within healthcare facilities'. 'However, citizens rightly complain,' he concludes, 'that if they book through the public route they have routes and bookings that are a long way off. If instead they ask for an intramoenia visit they have it in a short time. What could be done? Apart from thanking the doctors who make their time available in hospitals to treat citizens anyway, it is obvious that if the system is responsible, the bill to citizens should be paid by the National Health Service'.

The Fnomceo president's proposal is in fact already envisaged with the so-called 'skip-code', a guarantee path written in black and white in the waiting list plan (Article 3, law 107/2024) that provides for the obligation of the local health authority in the event of unfulfilled waiting times for treatment to guarantee it in the accredited private sector or in the hospital's intramoenia free profession. In practice, with the 'queue-jumping' system, if, for example, after a telephone call to the Cup to book an examination, a CT scan or a colonoscopy, the maximum times are not respected, which vary from a few days to a few months depending on the codes entered on the prescription (from 'urgent' to 'programmable'), the health authority must still guarantee the service within the set time, paying - in the private or intramoenia sector - instead of the patient, who at most puts his hand to his wallet to cover the cost of the ticket. The problem is that there is no automatism to trigger this 'queue-jumping' mechanism, and so the bureaucracy, as often happens in these cases, unleashes all its imagination. And so in the Asl (local health authorities) there is a flood of forms to be filled in, certificates and documents to be sent, perhaps only by Pec instead of an ordinary e-mail, and even in some cases the burden of having to prove with a piece of paper to the Asl that it was not possible to receive the visit or examination one needed because the same Asl was not able to guarantee it in time.