New Prospectives in the Italian Health System
Healthcare, green light for enabling law: new referral hospitals and greater integration with the local
community. More flexibility for doctors and openness to EU and non-EU professionals.
The Council of Ministers has approved, upon a proposal from Health Minister Orazio Schillaci, the
enabling law for the reorganization and strengthening of the National Health Service (SSN). This
structural intervention aims to make the healthcare system more efficient, modern, and responsive
to citizens' needs, strengthening integration between hospitals and the local community and
introducing new organizational models.
"We want a National Health Service better able to meet citizens' healthcare needs," stated Minister
Schillaci, "ensuring greater uniformity in the provision of services, in compliance with the principles
of equity, continuity of care, and humanization of treatment."
Third-Level Hospitals and Reducing Healthcare Mobility
Among the main innovations of the reform is the updating of the classification of hospital facilities,
with the introduction of third-level hospitals, centers of excellence with a national or supranational
catchment area, designed to reduce healthcare mobility and ensure high standards throughout the
country.
Alongside these, the measure provides for the identification of elective hospitals, acute care
facilities without emergency rooms, intended to accommodate non-urgent patients transferred from
higher-level hospitals. The goal is to improve the appropriateness of care and optimize the use of
hospital resources.
Community and Care of Fragile Patients
The enabling law devotes considerable space to strengthening community care, with particular
attention to dependent individuals, continuity of care, and the promotion of home care. Staffing
standards and new care models for patients with complex and advanced chronic conditions are
envisaged, in addition to strengthening palliative care.
The reform also aims to promote good clinical, healthcare, and organizational practices, strengthen
the integration of healthcare and social care, reorganize mental health services, and promote
clinical bioethics as a tool for humanizing care. This context also includes the reorganization of the
regulations governing general practitioners and pediatricians, who are called upon to play an
increasingly central role in community healthcare.
More flexibility for doctors and a fight against waiting lists
In parallel with the reform, Forza Italia has presented an amendment to overcome the
incompatibility regime that, since 1991, has limited the ability of NHS doctors to perform additional
activities in other public or private facilities. This proposal aims to reduce waiting lists by allowing
professionals, on a voluntary and paid basis, to offer additional hours.
Minister Schillaci has described the 38-hour fixed-term contract model as "anachronistic," paving
the way for greater organizational and contractual flexibility. According to the proponents, even
partial participation by doctors could generate millions of additional services each year, without
requiring new hires.
An opportunity for struggling regions, like Calabria
The new measures could also represent a concrete opportunity for regions experiencing a severe
shortage of healthcare personnel, like Calabria. This is the context for the recent request by the
regional president, Roberto Occhiuto, to facilitate the recruitment of doctors from European Union
and non-EU countries, to address the structural challenges of the Calabrian healthcare system.
The introduction of more flexible organizational models, the review of incompatibilities, and the
strengthening of the ministry;s role in the governance of the National Health Service could facilitate
the inclusion of foreign professionals, making the public system more attractive and helping to fill
staffing gaps in hospitals and local services. This strategy, if accompanied by integration and skills
recognition processes, could positively impact the quality of care and reduce healthcare mobility to
other regions.
Discussion with professionals
Signs of openness are coming from the medical community and trade unions, but also requests for
involvement. Cimo-Fesmed has welcomed the idea of greater liberalization of the medical
profession, while Anaao has reiterated that no reform can be effective without the full involvement
of healthcare professionals.
The legislative process is only just beginning: the implementing decrees must be adopted by
December 31, 2026. The government's challenge is to transform these reforms into concrete tools
to reduce the risks.
Prof Ettore Piero Valente
Di Aisc_News_Internazionale
