ROMA (ITALPRESS) – “The update of the Essential Levels of Assistance, which arrived at a distance of nine years, is a positive step for the National Health Service, but presents critical issues that should be addressed and exceeded.” So Tonino Aceti, President of Healthquity, expressed during the hearing to the Committee on Social Affairs of the House on the “Decretion Form of the President of the Council of Ministers amending and supplementing the decree of the President of the Council of Ministers 12 January 2017, on essential levels of assistance (LEA)”. Aceti first notes a problem of transparency in the performance selection process included: from the technical report it was not initially how many proposals were submitted to the Ministry. During the hearing it emerged that on 370 proposals for integration submitted to the Ministry of Health those approved were 91. A data considered essential for the quality of the decision-making process. Among the main criticisms, according to the president of Healthquity, are some normative inconsistencies. Chronic primary headache, recognized as a social disease by Law 81/2020, is not included in the Lea with an exemption code. Analogue situation for many patients with severe plaque psoriasis, which still cannot enjoy the exemption code 045, and for atopic dermatitis, highly impacting chronic pathology still excluded from exemption codes. On the oncological front, Salutequità judges positive the insertion of diagnostic tests for access to new drugs, but reports a short structural circuit: AIFA approves new drugs faster than the SSN updates the reimbursement of the tests needed to access them, with the risk of compromising effective access to care. Perplexity also on the prediction of only ten sessions of psychoeducational therapy for food disorders, insufficient compared to the clinical complexity of these diseases. “Among the structural nodes – Aceti continued – the issue of dentistry emerges strongly, today largely outside the perimeter of the National Health Service and dependent on household income. It is necessary to start a serious reflection on the extension of the public offer, recalling that oral health is an integral part of the right to health”. Employment also on the concrete implementation of the Lea. “I The in force and this new update – said Aceti – following the cancellation of the Decree tariffs by the TAR Lazio, are likely to be erased if it will not be prepared and approved by September 2026 of a new Decree tariffs. This is why it is essential to ensure in this process a timely involvement of the Regions, which, according to what has emerged, would not yet be fully engaged in the text and financial covers.” Further critical element underlined in the audition, concerns the financial impact and covers of the LEA round, built on the basis of a decree tariffs then cancelled by the TAR: “When tariffs are redefined – the president of Health added – costs may no longer coincide with those estimated and reported in the technical report of the measure, opening new margins of dispute.” Health has also called for a reform of the LEA update mechanism, which is considered too slow and bureaucratic, not in keeping with the needs of citizens, the technological, organizational and professional innovations of the SSN. The proposal is to establish a stable and independent authority, on the model of AIFA, able to guarantee a continuous update on the basis of the best and most updated scientific evidence. Also because the rules provide for an annual LEA update and the allocation of large resources, which cannot be wasted. Another highlight is the leopard application of Lea and the inadequacy of the monitoring system:“In the face of more than 142 billion transferred to the Regions for Health – said Aceti – the respect of LEAs is assessed with just 27 performance indicators, considered insufficient and too rigid.” Finally, the financing concept: “Today – Aceti has concluded – there is a robust methodology to calculate the real cost of LEAs and a strategic frame of reference. The last National Health Plan dates back to 2006, leaving the system devoid of a long-term vision. It is essential to review also the criteria for repartitioning the Health Fund and to overcome the reimbursement at performance, instead focusing on the financing of diagnostic-therapeutic-assistance paths and health outcomes, to ensure a real take-up of chronic patients and rare patients”. -photo Ipa Agency – (ITALPRESS).
