An editorial commentary by Paolo Poletti (Lecturer in Information Security Management at Link Campus University of Rome; Senior Advisor, ArtemisiaLab)
There is a recurring misconception in the debate on Italian healthcare: the idea that major transformations of the system are the result of individual technical measures – neutral, inevitable, and unavoidable. What has been happening in recent weeks, however, tells a different story. It reveals a method of governance that proceeds through the accumulation of isolated acts, without an overarching vision, without a coherent strategy, and above all without a clear assumption of political responsibility.
The issue is not whether a tariff schedule is more or less up to date, whether a pharmacy may or may not provide a given service, or whether the laboratory network should be reorganised. The real issue lies in how these choices are made and what systemic effects they produce when taken together.
The current national tariff schedule is a telling example. Tariffs built on outdated data – repeatedly criticised by administrative courts – continue to be applied, while the healthcare system, both public and accredited private providers, is forced to operate below cost. This is not a corporatist complaint, but a structural dynamic: when a service does not cover its real costs, supply contracts, waiting times increase, and the burden is shifted onto citizens. This is how waiting lists become a structural feature rather than a temporary anomaly.
Alongside this, the expansion of the so-called “pharmacy of services” is presented as a proximity-based response to citizens’ needs. Yet proximity, if not accompanied by equivalent guarantees of safety, risks becoming an illusion. The introduction of a dual regulatory standard – stringent requirements for accredited healthcare facilities and weakened or absent requirements for other settings – is not modernisation; it is selective deregulation. And it is difficult to argue that the protection of health can legitimately vary depending on where a service is delivered.
The third piece of the puzzle is the reorganisation of the laboratory network. Here too, the stated objective is understandable, but the method is questionable. Asking the system to reach high dimensional thresholds while uniform reorganisation criteria are still being defined means forcing Regions and operators to make irreversible decisions in the dark. In the absence of clear and stable rules, reorganisation risks turning into forced concentration driven solely by economies of scale, with the loss of local healthcare facilities and a weakening of proximity-based medicine.
Taken individually, these measures may appear technical. Taken together, they produce a very precise effect: incorrect tariffs, deregulation, and reorganisation imposed without clear rules amount to governing healthcare by inertia and opacity, with potentially irreversible consequences.
It is in this context that the position taken by the National Union of Outpatient Clinics and Polyclinics (UAP) must be understood. UAP has announced public protest and mobilisation initiatives in the coming days. This is not a sectoral reaction, but a stance explicitly taken in the interest of patients, the safety of care, and the sustainability of the National Health Service.
Because healthcare is not an area in which one can afford to “fix mistakes on the fly”. Every decision produces effects that ripple through local communities, affect the most vulnerable segments of the population, and shape citizens’ trust in the public system. Ultimately, this is a political issue in the highest sense of the term. It concerns how a State interprets the right to health. Because health is not a favour granted by the administration, nor a variable in an economic balancing act. It is a constitutional right. And rights, when they are undermined by inertia or opacity, must be defended.
