hadron therapy cured some types of cancer inoperable or resistant to traditional radiotherapy; enteroscopy with an ingestible microchamber (or video capsule) to examine any pathologies of the gastrointestinal tract without introducing endoscopes; optical computed tomography (Oct) to identify and monitor serious diseases such as maculopathy, glaucoma, retinopathy. And then: outpatient services from medically assisted reproduction (Pma) for couples unable to have children; tools and devices like cutting-edge digital hearing aids, latest generation prostheses, tilting wheelchairs. They are just some of the p
innovative restorations enter in the essential assistance levels (Lea) in 2017
So paid for by the National Health Service: in fact, however they are not available to everyone the assisted.

The spot

It’s waiting still publishing Interdepartmental decision that determines the updated rates of specialized outpatient and prosthetic care (for custom-made devices) to be reimbursed to suppliers. «It was supposed to be issued in February 2018 – recalls Tonino Aceti, president of Salutequità. The joke is that today there are innovative tools to cure many diseases, including rare and chronic diseases recognized in 2017, but patients do not have access to these diagnostic, therapeutic and prosthetic options because many of the “new” Leas are not operational».

Outpatient services 16 years old

Meanwhile, according to the transition rules, continue to provide services, allowances and aids included in the previous Leas

(2001), stop at 1996 for the specialist and at 1999 for prostheses«without prejudice to the prerogatives of the Regions”. What does it mean? «Regions that have their accounts in order can use their own resources to guarantee the new service to beneficiaries in the modality “extra-Lea”; they can’tinstead, the Regions in the recovery plan (almost all in the south and some in the center
) – answers Nino Cartabellotta, president of the Gimbe Foundation -. Yes they are exacerbated the inequality between North and South which, however, depend not only on the more or less efficiency of the regional organizational systems, but on a issue What’s upstream p
because many new benefits are not payable throughout the national territory have not been approved “Tariff decision”
». «Each region has decided to provide its residents with the services it deems a priority, but there may also be differences between different local health authorities – intervenes Anna Lisa Mandorino, general secretary of Cittadinanzattiva -.
I am
“jump” the essential levels of assistance, where patients are forced to travel at their own expense to receive treatment».

The appeal to the minister: resources fixed in the budget law

After the first ministerial version Has been turned down in January 2022 by the Conference of the Regions, in september it was waiting for the last step: the Agreement between the State and the Regions new design decisionwhatever it was “stripped” off the agenda of the session. That’s what the report says so far Conference of the Regionsthe coordination of the Health Commission evaluates the economic impact of the application of the new rates.
«The Minister of Health clarifies with the Regions about the resources that are missing and that must already be allocated (and finalized) in the new budget law to be approved by the parliament – suggests Aceti -. Aid must be adapted to people’s needs. A call for agreement is also launched by the secretary of Cittadinanzattiva: «We ask for a dialogue between institutions, because i Lea’s performances and services not optional though essential matters that must be guaranteed equally and uniformly for everyone Mandorino points out. If this right is denied, all that remains is to claim it in court».

Lifesaving test denied for many newborns

The extensive newborn screening – Offered free of charge to all newborns for the early diagnosis of a broad spectrum of congenital diseases, in accordance with the 2017 Dpcm on the Lea – in some regions it is also done for Spinal Muscular Atrophy (Sma) and other rare pathologieswhile in other regions, newborns do not have the same right.
A woman with breast cancer in the early stage it can free genomic test at your expense in Lombardy or Emilia Romagnainstead in some other regions it is not accessible through the National Health Service. Why is this happening? «The reason – answers Anna Lisa Mandorino – is that these and others benefits (and illnesses) I am the
no
“waiting list”
that is waiting to be included in the essential levels of assistance,
Which not They were updated despite the green light from the “National Commission to update the Lea
”». That “update delays” persist is underlined by the Court of Auditors in the «2021 General State Accounts Report» (June 2022): «The obstacle is the non-approval of the maximum rates». The hub is again the “Tariff Decision”, without which it is not even possible to implement the updates.

Genomic testing only in some regions

What does it mean for the supervised? Mandorino gives some examples: «All newborns – and not just those who live in some regions – could do it extensive newborn screening
also for Sma and other rare congenital diseases, which allows early identification of these pathologies, allowing immediate start of available treatments that can prevent serious damage or save the life of the child itself”.
«In breast cancer – continues the secretary of Cittadinanzattiva – the inclusion of genomic testing in the essential levels of assistance would ensure equal access for those entitled to it (and not just for some people) allowing doctors to choose the most appropriate therapy for that patient. Again: all people with fibromyalgia would no longer be invisible for the National Health Service, but would be entitled to the services necessary for diagnosis and treatment”.

Making innovations immediately available

These are delays that violate the «continuous updating» of the Lea, established by the 2017 standardto adapt them to scientific evidence. «Innovations in diagnostics, therapeutics and rehabilitation must be immediately available to patients who need them
– underlines Nino Cartabellotta, President of the Gimbe Foundation -. In fact though the bureaucratic procedures for the approval of the new Lea take a long time rrespect for the goal of “a health service that is always in step with technological and scientific innovations and with the needs of citizens”. Lcontinuous update of the Leas
– suggests Cartabellotta – it must be a dynamic process: just as science periodically produces new achievements, the system must be ready to welcome them, excluding the obsolete».