ROME (ITALPRESS) – Incentivizing births is a priority both from a demographic point of view and for the country’s social condition, and with the entry into force of the tariff decree, scheduled for Dec. 30 next year, in which access to medically assisted procreation techniques is recognized as a LEA, an essential level of care, every individual (or rather, couple) has the right to timely, safe and quality access wherever they reside in our country.An end to the inequity, therefore, with which couples have so far been confronted, both in terms of cost, having defined a fee for services and the cost of the corresponding co-pay for homologous, and in terms of the number of cycles that can be provided, to date varying from 3 to 6. And end also of differences in access criteria, i.e., at the “barrier” age for women: to date, we go from the age of less than 42 in Umbria to 50 in the Veneto Region, to Regions that have different age limits for homologous and heterologous (e.g., Tuscany Region 43 for homologous, 46 for heterologous).Now, with the entry into force of the new LEAs, the maximum age of women is 46 and the number of cycles equal to 6.But not everything is solved if a series of risks will not be avoided-five of the most obvious ones-that could create problems for couples, the NHS, and the country grappling with a generalized demographic winter: Istat predicts a more pronounced negative decline in the South (up to -4.8%), compared to the North and the Center. The demand for PMA will of course increase, and the first alarm comes from the latest Report to Parliament, which points out that “there remains the different distribution of public and private contracted centers, which are more present in the North of the country… In addition, a substantial number of Level II and Level III PMA centers in the country perform a small number of procedures throughout the year… It would be desirable for PMA centers to be able to carry out congruent volumes of activity so as to ensure quality, safety, and appropriateness of procedures in PMA techniques and to be equally distributed throughout the country to offer the best possible level of performance.”The new risks to be averted were analyzed by the Salutequità Observatory, which already last year analyzed the problems of this important service.If demand increases, the supply through the SSN presents inequalities in quantity, as well as quality and safety, the first risk is that of an interregional health mobility destined to increase (and which risks impoverishing the regions most in difficulty). In 2021, 41.5 percent of cycles using donated gametes were carried out in centers in a region other than the region of residence (mobility): in most cases it is to public or private contracted centers in Tuscany and Lombardy and to private centers in Lazio. The number of cycles performed on patients per million inhabitants is another important parameter for understanding regional supply. The standard of adequacy, according to the scientific society ESHRE, is 1,500 cycles per million inhabitants.There are 14 regions that do not reach this standard-where mobility is therefore at high risk. Many southern regions/islands (Marche, Umbria, Abruzzo, Molise, Apulia, Basilicata, Calabria, Sicily, Sardinia, Liguria) are below 1,000 cycles; Marche (180), Molise (355), Sardinia (543) record the lowest values. Exceeding 1000 cycles, but not reaching 1500: Veneto (1113), Piedmont (1198), Friuli-Venezia Giulia (1155) and PA Trento (1398). Above the standard (1500 per million inhabitants), Valle d’Aosta (4429), PA Bolzano (3380), Tuscany (2961), Lombardy (2221), Lazio (2139), and Campania (1559).In addition, the moment the service enters the LEAs, the boundaries for accessing the service paid for by the SSN widens to the European dimension, due to the effect of the directive on cross-border care. The second risk is of increased waiting times and the existence of the requirements for mobility within European borders at the expense of the SSN.One of the reasons why authorization for cross-border care cannot be refused is when the health care in question cannot be provided in Italy within a clinically justifiable time frame. So monitoring of waiting times becomes even more necessary. But on this, at the moment, there is no monitoring system at the national level.There are, however, interesting practices on the ground that try to fill this information need developed in Piedmont, Basilicata, Veneto, and Tuscany. The third risk is that of failing to ensure pathways for infertility prevention and care. According to the CCM (National Center for Disease Prevention and Control) project “Analysis of the activities of the network of family counseling centers for a re-evaluation of their role with reference also to problems related to endometriosis” offer interesting indications.The results show that “in our country there are too few family counseling centers compared to the needs of the population (one counseling center for every 35,000 inhabitants although they are recommended in the number of one for every 20,000).” Taking the need for one counseling center per 20,000 inhabitants as a reference, Agenas through the statistical portal shows that 16 regions lack 919 counseling centers. There are more missing in Lombardy (-268), Lazio (-131), and Campania (-163).The fourth risk is the inequity generated by differences in cost for access to heterologous. The new LEAs stipulate, in the case of gametes from outside the couple, that fees are defined by the region. This is because gametes have to be imported from abroad and costs vary depending on the agreements that can be made.There are Regions that have already worked and invested to improve the offer for heterologa – by virtue of a more structured and consolidated offer over time – and have used their own funds and those provided by Budget Law No. 178/2020. According to the latest Report to Parliament, for example, Emilia-Romagna and Lombardy, which are also among the regions with the most active mobility, have invested fund resources to strengthen and better structure the supply for heterologous, creating a “regional gamete bank” that can take care of procurement from abroad/banking/distribution at the PMA centers.The fifth risk is the absence of monitoring and evaluation of the actual guarantee of this “new right” for all couples who need it and in all regions.Like all new LEAs, PMA has not yet been declared the subject of evaluation and monitoring in the New Guarantee System. Yet PMA benefits from an important tool that the National PMA Registry established at the ISS, which provides valuable data and information on many aspects and which could be supplemented with indicators on waiting times. Acting on these risks means activating important levers to finally ensure equity even for those who, for many years, have seen access to care guaranteed to people in the same condition betrayed, but who had the good fortune to reside in territories with a different zip code from their own. “Making PMA truly effective and efficient is not only an advantage for health,” comments Tonino Aceti, president of Salutequità , “but also a support for the country system grappling with a birth rate that puts the entire economic and social stability at risk. Having overcome the hurdle of inclusion in the Lea and the tariff decree, we can no longer run the risk of further complications: the unbearable disparities in access must no longer exist, and PMA must be the same in every corner of the country. It is urgent that PMA become the subject of monitoring and evaluation in the New LEA Guarantee System, integrating the system currently guaranteed by the Registry established at the ISS with access times, as well as adjusting the supply on the territory in qualitative-quantitative terms. Otherwise, mobility will erode important resources for the sustainability and qualification of services in some territories. And couples who cannot afford to travel to access services will continue to be penalized. “The Salutequità Observatory is produced with the unconditional contribution of Bristol Myers Squibb, Incyte Biosciences, UCB Pharma, Menarini Group, BeiGene Italy srl, Ipsen S.p.A., Merck Serono SPA, Organon Italia.
– IPA Agency Photos –
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