Long waiting lists? The law (little applied) that makes the local health authority pay for treatment

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Waiting lists are patients’ number one enemy, so much so that around 3 million Italians of the total 4.5 million who gave up on treatment in 2023 did so precisely because of too long waits for treatment. A national emergency once morest which the Government also wants to try to take action with a legislative decree will soon be heard by the Council of Ministers. Few people know, however, that for over 20 years there has been a rule that “defends” patients forced to wait beyond the maximum expected times and that allows those who wait too long for a visit or examination ask the local health authority to pay for the service intramurally (freelance profession within the hospital). For the citizen who at most will only have to pay the ticket, it is not easy to activate this procedure also because the CUP and the local health authorities do not warn them of this possibility, which is why patient associations have multiplied ready to assist them by making available ad hoc modules.

What does the standard approved over 20 years ago provide?

As mentioned, the regulatory measure dates back to over 20 years ago and in particular to Dlgs 124 del 1998 which without too many mincing words provides that if the wait for a healthcare service exceeds the expected deadlines (based on the urgency there are codes and maximum waiting days) then the patient can ask «that the service is rendered in the context of the intramural freelance professional activity, placing the difference between the sum paid equally at the expense of the local health unit company to which it belongs and of the local health unit company in which the service is requested. as a share in the cost of the service and the actual cost of the latter, based on the tariffs in force”. In practice, the patient will be able to take the visit and examination intramurally by paying if the ticket is not exempt. However, if “the patient is exempt from the aforementioned participation, the local health unit company to which he or she belongs and the local health unit company within which the service is requested correspond, in equal measure, to the entire cost of the service” .

Practical advice for obtaining the service paid by the ASL

But how can local health authorities enforce the rule? The procedure is not automatic and patients in many cases are forced to face the reluctance of the Cup which, in addition to not informing citizens of this possibility, often ignores citizens’ specific requests to resort to intramoenia. This is why various associations have created forms for requesting the Local Health Authority which many citizens throughout Italy are using. The practical advice for those who want to access this procedure is quite simple: when the doctor prescribes a visit or test, he must assign a code (if he does not enter it, he must insist on writing it down): «U» stands for urgent (appointment within 48-72 hours); «B» for short (within 10-15 days); «D» stands for deferrable (within 30-60 days) and finally «P» for programmable (within 120-180 days). When booking the service at the counter or at the Cup, if the appointment is scheduled following the times established by the priority code, the appointment must still be confirmed. At that point you make a request to the local health authority – preferably with a pre-filled form – to immediately obtain the intramoenia service and the local health authority will be forced to contact the patient to arrange the visit or examination at your expense.

The initiatives of the Regions to comply

It is not excluded that the Local Health Authorities and the Regions will resist the requests of citizens who, however, have every right – given that the law allows it – to obtain the service intramurally. In Piedmont, for example, following the complaints of several patients, the Health Department issued a circular to remind the local health authorities of the possibility of applying Legislative Decree 124/1998, clarifying how to guarantee intramoenia services when the deadlines established in the prescriptions cannot be respected. In particular, it is specified that, if a patient cannot obtain an appointment within the times established by the CUP, you can contact the Local Health Authority’s Urp to organize the paid visit or exam, covered by the Health Service. In recent days, the Lombard councilor Guido Bertolaso ​​also clarified that the 1998 law does not provide for reimbursement for a service carried out privately but only if internal intramoenia is used: «Whoever claims that in the case of a lack of response indications can go in the private sector, paying and then getting reimbursed – he underlined – is saying something that is not true. If that structure, following having made all attempts to provide the service, is unable to guarantee it within the expected times, within the territory of the ATS, then it can do so through internal solvency, i.e. using its own professional”.