The allergist is recognized in the Lea as a prescriber of highly specialized investigations and solely responsible for the assistance process in the event of allergies to hymenoptera, drugs and food. The problem of the adequacy of the proposed tariffs, in the absence of a definitive decree, puts high-level allergy diagnostic services in the public sphere at risk. This is the appeal launched by Aaiito (Association of Italian territorial and hospital allergists, immunologists), during the national congress underway in Florence
One of the hot topics of the four-day congress is the future of allergology in Italy. The National Health Service provides the health services included in the essential levels of assistance (Lea) through public providers (Health and hospital companies, university hospitals, public Irccs), and equivalent private providers (private Irccs, classified hospitals and “principals”) or accredited, with which the Regions and Companies enter into agreements or contracts. All providers of the NHS are remunerated according to rules established at regional level, within the reference regulatory framework established at national level to guarantee the homogeneity of the system.
“Despite the publication of the new Nomenclator of outpatient specialist services, consisting of 2,108 services against the 1,702 of the 1996 version, and which introduces highly innovative elements, we still remain without a definitive decree – explains Riccardo Asero, Past President Aaiito – due to the lack of agreement on the relative tariffs in the State-Regions Conference, indispensable for its concrete application and publication in the Official Gazette”.
Aaiito tried to contribute to the review by participating in institutional tables and by interacting with the Ministry of Health and obtaining recognition of the role of the allergist as a prescriber of highly specialized investigations and as sole responsible for the care process in case of allergies to hymenoptera, drugs or food, but the problem of the adequacy of the proposed tariffs remains hot. At present, according to the association, they are too low. And the risk is that they will be further compressed due to the economic constraints that characterize Italy in terms of financing the NHS. As confirmed by the update note to the Def (Nadef), recently approved, the GDP/health expenditure incidence is destined to further contract over the next three years, going from 6.6% for 2023 to 6.2% for 2024 and 6% for 2025.
“There is therefore the risk that, in this context, the diagnostics manufacturers no longer supply their products to the public supplier and make them available only to private individuals at a more reasonable price”, underlines Battista Roberto Polillo, allergist specialist of the council directive Aaiito.
A problem that arises again for outpatient specialists directly involved in the care of patients if we consider that the rates proposed for a first specialist visit or a follow-up visit amount to approximately 23 euros and 18 euros respectively. “It is no wonder that, also in light of the considerable and often intolerable workloads due to the shortage of medical personnel and the exhausting bureaucratic-administrative procedures for the dispensing of medicines, there is a “leakage” of specialists from the NHS structures and the their landing in the private sphere”, concludes Polillo.
In the long run, there would be the risk that this situation would translate into the impossibility of providing high-level allergy diagnostic services in the public sphere, complains Aaiito, and the transfer of users to the private sector. “It should be considered that this situation occurs starting from a historic undersizing of public allergy services in a country where 25% of the population would need them – underlines Asero – a bleak picture that our association has been denouncing for years without the political decision-maker has yet concretely decided to remedy, substantially involving scientific societies and professionals who directly operate in the field”.
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