Tempi di attesa e costi delle prestazioni nei Sistemi Sanitari Regionali

The C.R.E.A. 2017 Healthcare Survey for the CGIL Observatory on waiting lists and cost of services in the Regional Health Services was conducted in 4 Italian regions: Lombardia for the North-West; Veneto for the North-East; Lazio for Central Italy and Campania for the South. The survey highlights the concerns about the impact of waiting lists on access to the NHS and, hence, on its universal nature. The issue has two obvious "regularities": the first is that the discriminating factor is the system for paying services. In fact, those falling within the NHS scope (free of charge except for the possible prescription fee) have long waiting lists and, in some cases, very long ones: rarely they are provided within 30 days in public structures and often exceed this term even in the private accredited ones. Conversely, for the services provided not for free (both by private physicians in public structures - the so-called intramoenia regime - and for paying patients in the private structures) waiting lists are very short. The difference between these two "regimes" (paid or free of charge) is much larger than the difference in waiting lists between public and private structures. Although the waiting lists in public structures are longer - although not in a generalized way - they are not significantly longer than in private ones. Similarly, for the paid ones, the differences in waiting lists between the public and private structures are negligible. The same holds true for prices, which are not very different between the public structures (under the intramoenia regime) and the private ones (outside the NHS scope): indeed, in some cases, a higher cost is recorded under the intramoenia regime. It should also be noted that private prices are very competitive with regard to the services provided by the NHS and subject to co-payments and cost sharing. It is therefore evident that the waiting lists risk not being in line with people's expectations (the analysis was conducted on services not prescribed as urgent). Altogether, co-payments and cost sharing - in turn - risk not being in line with the market value of services, thus resulting in a severe inefficiency of the NHS, which is to be seen as a driver of the private structures' competitive positioning. In other words, timely access seems to be a condition guaranteed by the NHS only for urgent services, while it turns into a "paid service" in the remaining cases (which are certainly prevailing in number). Paradoxically, the second regularity is due to "the lack of regularity", if not in the aggregated data, at regional level. Although the average data surveyed shows some significant differences at regional level, a great variability between regions and also between structures and services is mainly recorded. Furthermore, there is no correlation between waiting lists and regional characteristics, neither at geographical level nor at service structure level. In fact, the share of private "presence" in the Regional Health Services does not correspond to a difference in waiting lists.