Necessary and urgent measures in Anti-waiting list decreesuch as the National Platform, the Health Care Verification and Control Body, the strengthening of the system for booking services through the CUP – Single Regional Booking Centre, and also those relating to personnel. But the risk is that without some fundamental corrections, we will not be able to concretely ensure that change of pace expected by citizens. This is what is requested by Tonino Aceti, President of Salutequitàa laboratory for the analysis, innovation and change of health and social policies, which yesterday in a hearing in the Senate Committee on Social Affairs, Health, Public and Private Employment, and Social Security illustrated point by point the lights and shadows of decree 73/2024 (and its conversion bill), starting from paragraph 10 of art. 3 of the Legislative Decree, on how to effectively enforce the citizen’s right to obtain the benefit he needs in the event of failure to comply with the maximum times set by the reference legislation.
“Paragraph 10 of Article 3 – Aceti explained – represents one of the most delicate and at the same time most important parts of the entire provision, since it establishes in the company general management the responsibility to guarantee, in the event that the maximum waiting times are exceeded, the provision of services to the citizen, as well as the activity of supervision and exercise of disciplinary action and financial liability towards the subjects who are attributable to the failure to provide the service to the assisted person”.
“A principle that we fully share – he added – already provided for in other provisions, but which risks, without the introduction of corrective measures, remaining once again on paper and not representing a concrete solution to the difficulties of access to care by citizens. Precisely for this reason we ask that a specific time be provided, between 24 and 48 hours from the citizen’s phone call to the CUP, within which the company general managements must guarantee the identification of the appointment date in compliance with the timing of the priority codes attributed by the medical prescription, automatically contacting the citizen again via the same CUP (or another office) and within a guarantee area that always responds to the principles of reachability and proximity”.
Still “too often – Aceti observed – it is the citizen who is forced to chase the offices of the ASL and hospital companies to try to obtain the health service with telephone calls and by sending forms and counter-forms and/or to travel even more than 100 kilometers by car or public transport to reach the place of the health service. A situation that this decree must put an end to immediately, if we really want to combat the phenomenon of giving up on treatment and not force citizens to resort to private care. We also ask that this protection not only be valid for 2024, but be a right for all years to come. In fact, the economic coverage identified by the decree refers only to 2024 and presents several critical issues, starting from the fact that the resources could, in part or totally, already have been committed by some Regions”.
The first measure to be adopted, as illustrated by the president of Salutequità, is the establishment of the National waiting list platform. “You can’t govern a phenomenon that you don’t know and can’t measure, and today we don’t have any truly reliable data on waiting lists.” The second is the establishment of the Health Care Verification and Control Body, which strengthens monitoring and control at the central level, especially after the approval of the law on differentiated autonomy that gives the Regions further room for autonomous maneuver. “The body will allow citizens to report directly and in real time, situations of non-compliance with rights.”
Well, according to Salutequità, the forecast of the strengthening of the system of booking services through the regional Cup, which concerns both public and accredited private facilities that must adapt to the new decree law, under penalty of losing accreditation with the Regional Health Service. Positive are the measures in which it is expected that the resources for the recovery of waiting lists by the Regions cannot be used for different purposes, as well as the different measures regarding health personnel.
Among the critical issues highlighted by Aceti, the National Platform “does not explicitly provide for monitoring compliance with maximum waiting times“, as it only speaks of “modulation of waiting times in relation to priority classes”. Furthermore, the flow should also provide information on floating lists (currently not specified), correct provision of intramoenia activity (dimension not specified), guarantee of agendas dedicated to Pdta and their respect (dimension also not specified). With respect to the audit activity granted to Agenas by paragraph 6 of the same art. 1, the definition of a consequent-possible Plan for the enhancement of the critical Lea by the Regions is not expressly provided for (institution provided for by the Health Pact 2019-2021), nor is any mechanism for administration provided for in the event of regional immobility/non-compliance.
Among the measures to optimize regional health planning, “the adoption and compliance with the Pdta refers only to some pathologies, leaving out for example rare diseases, as well as at the moment there is no reference to the definition of pathology networks, to the increase and monitoring of the level of adherence to therapies, as well as to the strengthening of Integrated Home Care (Adi)”.
In the critical issues chapter, then, the economic coverage. “For the Health Care Verification and Control Body, it is expected to provide for the greater costs expected for 2024, by means of a reduction in the resources foreseen in the budget and intended for transactions to be stipulated with subjects damaged by transfusions with infected blood or blood products”. And “no additional resources – added Aceti – also with regard to the article on the strengthening of the healthcare offer”.
As for personnel – Salutequità points out – if on the one hand an initial overcoming of the spending limit for hiring is positive, on the other hand we must deal with the lack of operators and the scarcity of the relative coverage.
“Increasing the spending ceiling without providing for an increase in funding for the NHS – Aceti stated – implies a necessary compensation on other spending chapters for assistance and therefore for the provision of Lea already in sharp deterioration in 2022 (last year available) also according to the Court of Auditors”. Furthermore, “no measure to immediately correct the serious distortion of the New Lea guarantee system, which currently can only count on a core indicator regarding waiting lists (whose calculation method is highly questionable) and on no core indicator relating to the guarantee of Pdta”.
Finally, Aceti recalls how the decree-law “refers to a multitude of further decrees, the timely adoption of which will be very important to monitor, under penalty of the ineffectiveness of the entire provision”.
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