ROMA (ITALPRESS) – “Health rates are the amounts recognised by the National Health Service to public and private facilities accredited for each visit, examination or treatment provided to citizens. If these amounts do not cover the real costs of performance, to be damaged are not only the dispensers, but the entire healthcare system and, first of all, the patients.” This is what we read in a note by Mariastella Giorlandino, President UAP, who adds: “When accredited private health fails to cover the costs of personnel, reagents, energy, technologies, maintenance and security, it is forced to reduce the offer, postpone investments or limit the performance made on behalf of the SSN. There are fewer services available, longer waiting lists and more household spending. Public health facilities are also directly affected by the effects of insufficient rates. The benefits are valued at amounts that may be lower than the costs actually incurred, resulting in budgetary imbalances and lower resources for staff, innovation and investments.”.
“The tariff decree of 25 November 2024 – continues the note – had foreseen amounts held insufficient by numerous operators. The TAR Lazio, with multiple judgments, has annulled it effectively, detecting shortcomings in the investigation and methodology: it was not adequately understandable on the basis of what data and through which steps tariffs were determined. It would therefore be expected that the new procedure was based on maximum transparency and a prior comparison with the representative organizations of public and private accredited structures. The opposite happened. The new draft was brought to the attention of the press without the category associations being first convened to examine the data, the criteria used and the concrete effects of the new tariffs. The public diffusion of the scheme is not disputed. It is disputed that the communication preceded the comparison with those who give daily performance and knows its real costs. From the available documentation it is not possible to know with sufficient precision how many structures and how many observations have actually been used for each branch, what data have been excluded and how much the final sample is representative of the different territorial and dimensional realities of the National Health Service. For many sectors, the Ministry has not determined the cost of the single service, but has used average values for whole cost centers or for groups of services.
The FA-RE classification was used for this purpose (by the names of the authors: Fadda and Repetto), originally developed for the Emilia-Romagna Region. The method combines similar performance in one group for technologies used, personnel needed, materials, duration and organizational modes. The Ministry has therefore compared the total cost of the group with the theoretical revenues produced from the rates. The problem is that an average of the whole group may appear balanced and, at the same time, hide individual severely sub-remunerated performances. It is also not sufficiently explained why a model developed in a specific regional context has been assumed as a national reference, nor how the average results of the groups have been transferred to the tariffs of the individual codes.
Emblematic is the case of the lab. An average cost and revenue ratio of 99.7 percent is assumed as evidence of the substantial adequacy of tariffs. This figure does not show, however, that each individual examination is properly paid: loss performance can be compensated, on average, by other more remuneration. This adds the exclusion from the sample of laboratories with less than 200,000 annual performances, with the risk of building tariffs mainly on the model of large operators, without adequately considering the costs of spatial proximity and the role of small and medium-sized structures. The threshold of 3 percent must also be clarified.
The Ministry has established that, when the difference between the costs detected and theoretical revenues produced by the tariffs remains within 3 percent, the tariff is not changed. However, it is not sufficiently illustrated that this percentage has been chosen or whether the same threshold is reliable for sectors characterized by very different samples, technologies and costs. The criteria with which the values considered abnormal and the effect produced by such exclusions on the final results are also not transparent.
At this point it is legitimate to ask whether the procedure followed is actually pursuing the public interest, which is not to formally maintain low rates, but to ensure that citizens are effectively available, timely and of quality, without transferring to the budgets of public and private structures the cost of insufficient remuneration. UAP therefore asks the Ministry of Health to immediately suspend the process of drafting, to make known the data and criteria used and to convene with urgency the representative associations of the dispensers before the concert with the Ministry of Economy and Finance and the conclusion of the passage in State-Regions Conference. Without sustainable tariffs, public accounts are not protected: performance is reduced, expectations are extended and the entire national health service is weakened”
– Photo Ipa Agency –
(ITALPRESS).
