The debut of the new tariff for specialist healthcare and prosthetic services he was blocked on the wire. On the day set for its entry into force, the Regional Administrative Court of Lazio froze everything with a precautionary suspension. The decreesigned by the Ministry of Health on November 25th, should have revolutionized the rules from December 30th. But a maxi-appeal signed by hundreds of accredited healthcare facilities and supported by the main trade associations, it stopped the plan.
The Achilles’ heel of the measure
The appellants made no concessions to the decree, accusing it of superficiality. The main criticism is based on one poor analysis of current economic conditionscombined with questionable methodologies. The lawyers Giuseppe Barone and Antonella Blasi, on the front line for the appellants, were clear: “We are convinced that the provision violates the constitutional principles of efficiency and good performance of the public administration”. The finger is pointing up rates which, according to them, they do not take into account rising costspost-pandemic complications and economic crisis. A difficult and intricate situation, also considering the insufficient healthcare funds included in the Budget Law.
An update that has been awaited for decades
The new price list, which promised over three thousand free services, had been approved at the State-Regions Conference and represented the first substantial update after 28 years. It had to align the system with the new Essential Levels of Assistance (Lea), reforming the Tariff Decree of 23 June 2023. A revolution that remained only on paper, but for the applicants it translated into cuts to refunds reaching up to 70%. An ax especially for the structures of the Centre-South, already in a precarious balance.
An eight year long battle
There is no peace for the new Essential Levels of Assistance (Lea), awaited by Italians from referral to referral for eight years. From 30 December, officially, new treatments would be available to citizens paid for by the National Health Service: from medically assisted procreation to new oncological therapiesAnd. But on the very day in which a new page for public health had to be written, the Lazio Regional Administrative Court put everything back in the balance. The suspended decree was not limited to introducing new LEAs, but it also updated 1,113 tariffs relating to visits and specialist tests out of a total of 3,171 services present in the nomenclature.
The chaos of the platforms and the risk of paralysis
This twist has thrown an already tested system into chaos, creating apocalyptic situations like a bureaucratic nightmare. The local health authority platforms had already started using the new codesand 300-400 thousand prescriptions based on the new tariff have already been issued. A hard blow for a project on which the Ministry of Health has been working for two years and which had already faced postponements under pressure from the Regions. The new LEAs and tariffs, in fact, were initially expected for January 2024, then postponed to April, until reaching the fateful 30 December.
The reasons of the TAR and the resistance of the Ministry
The Court accepted the precautionary request of the trade associations, who hailed the decision as a “great victory” (only them, in all likelihood). “The new decree was adopted after more than 20 years by the previous nomenclators, thus outlining the lack of urgency”, we read in the motivation. THE’collegial hearing is set for January 28, 2025but in the meantime the Ministry of Health is not sitting idle. In these hours he is preparing a emergency appeal to the Council of State to try to save the nomenclature and the new services, at least temporarily, while awaiting the final verdict.
Treatments that risk remaining on paper
The TAR’s block risks once again postponing the entry into force of healthcare services expected from 2017 and for which over 500 million euros have been allocated. Among these, assisted procreation, new aids and prosthesis such as digital hearing aids and home automation equipment, advanced newborn screening and diagnosis of pathologies such as celiac disease, endometriosis and rare diseases.
On the oncology front, innovative therapies such as stereotactic radiotherapy, hadrontherapy and the robotic arm for highly targeted treatments are expected. Cutting-edge diagnostic technologies, such as computerized optical tomography for ocular pathologies and videocapsules for intestinal diagnoses, remain a mirage for now. And all this while the country is aging and the demand for advanced care is growing.
The repercussions for those with fewer resources
The suspension of the new healthcare tariff is a real slap in the face for those who struggle every day to make ends meet. This update was alifeline for those who cannot afford private treatment. And there are also numbers. According to a report by the Pharmaceutical Bank, in 2024 beyond 430,000 people are in conditions of health povertythat is, they cannot afford the necessary care.
With the old tariffs still in place, many people find themselves forced to choose between unaffordable expenses or give up essential care altogether. Or worse yet, they will find themselves forced to take refuge in the emergency rooms, already reduced to the bare bones and in a staffing crisis. And it doesn’t end here: the territorial disparities are destined to get worse. Regions with fewer resources or bound by recovery plans will hardly be able to plug this hole, leaving a gap in healthcare that risks hitting the most vulnerable groups in the country.
The blocking of the new tariff is a low blow that comes at the end of the year, a moment in which many families take stock and, for many, those sums are no longer enough. Public health, which it should be a universal pillar (unless we want to get closer to the US model, which is not exactly fortunate in this exact historical moment), it increasingly seems like a luxury for the rich, with essential care transformed into objectives that are out of reach.
