Health Minister Orazio Schillaci said Press that in the last year lists and wait times for tests and visits have no longer gotten worse and have even started to decrease. However, the data cited by the minister say much more: it is true, there has been an improvement, but the progress has been minimal, almost imperceptible, as shown by the dissatisfaction and complaints of patients in every Italian region. It is so minimal that it will take 40 years to achieve the goals set by law.
The data to understand the progress comes from the national waiting list platform, which launched online at the end of June. It’s a tool that has been talked about for years, but never used due to resistance from the regions that manage health services in Italy. The platform collects all data on test bookings and visits made at hospitals or clinics either through the national health service or by doctors in a freelance regime, called intramoenia. The data is sent every month by region.
These platforms must guarantee transparency, in reality it is not easy to read and interpret the data. Marcello Crivellini, professor of health systems analysis and organization at the Polytechnic of Milan, analyzed it for Luca Coscioni’s association which has been working on civil rights and the right to health for many years.
Regarding exams, data shows that from June to September, just over 25 million were booked. Of this number, 10 million were immediately accepted and put on the waiting list according to the deadline set by law, almost 15 million were rejected: some patients preferred to wait a long time, even exceeding the limit specified in the prescription, some turned to private facilities, some refused the test.
However, of the 17.7 million visits recorded, 6.1 million visits were directly accepted and 11.6 million visits were rejected.
The conclusion of this analysis is that in the first nine months of the year, 58.1% of exams were conducted beyond the time required by law and only 41.9% met the deadline. The situation was even worse in terms of visits: 64.2% did not comply with the times, while only 35.8% finished on time. Add exams and visits, 39.4% value time, 60.6% are late.
Crivellini also monitors trends over time, a useful operation to understand whether the situation is improving or not. Compliance with exam times improved by just 0.2 percentage points from July to September, from 41.7 to 41.9%, while compliance with visits worsened by 0.2 percentage points, from 36 to 35.8%.
The goal is to reach 90%: «If small improvements persist as they have in recent months, it will take 40 years before compliance with exam wait times occurs. The data shows that the current strategy of the Ministry of Regional Affairs is insufficient”, said Crivellini.
There are two possibilities for reducing waiting lists: on-demand interventions, i.e. limiting the number of tests and visits, or increasing supply.
In recent years the government has always chosen the second option. A decision approved in the summer of 2024 with the aim of reducing waiting times has allocated around one billion euros over three years. The money is used to extend working hours by conducting exams and visits even on Saturdays and Sundays or at night. The government has also spent 250 million euros to make overtime more affordable, taxing it at just 15%. Additionally, spending limits imposed in 2009 on recruiting health workers have been removed.
When the decision was approved, the doctors’ union had already warned the government about the possible ineffectiveness of these measures, which are almost entirely economic in nature. In fact, doctors already work long hours a week, often exceeding the rest limits prescribed by European law, and according to investigations carried out by unions in recent years, many doctors suffer from symptoms of the disease. blackout.
The decision does not intervene to control implementation through so-called “prescriptive compliance”, that is, appropriate requests for tests and visits. Appropriateness of prescriptions is not respected when doctors – general practitioners or specialists – prescribe more medical tests than necessary. One of the factors driving this demand is so-called “defensive medicine”, namely the use of a large number of tests and visits to prevent the risk of complaints from the patient or his relatives. This attitude causes tests to be carried out without respecting the protocols prescribed for tests related to various diseases, thereby significantly increasing demand which then affects waiting times and registration.
In an interview with PressSchillaci said that one way to improve this situation is to limit the possibility of doctors to practice their profession in public structures, namely in government institutions.intramoenia. Through intramoenia, public health makes booking systems, clinics and hospital machines available to doctors. The cost of a visit or test, which is higher than for a visit booked through a public service, is usually split 80% to the doctor and 20% to the hospital, but it is up to the hospital to decide how much to pass on to the doctor.
According to Schillaci, free profession is a right that cannot be denied in public service. Therefore, the ministry is considering a temporary suspensionintramoenia at least in the most problematic structures. «The problem arises when there are more paid services than national health services, when people wait for six months andintramoenia two weeks. If the imbalance precludes the right to treatment, a temporary suspension may be considered. The agreement is clear: first the community, then the private partners. When we see critical issues, we intervene to ensure justice.”
