Maurizio Casasco: “Overcoming the payback mechanism to avoid repercussions on businesses”

The MPs Casasco, Cappellacci, Benigni and Patriarch commit the government to change the payback mechanism. “From a programmatic perspective it is necessary to overcome the payback mechanism for the years from 2019 and following, in order to avoid both highly negative repercussions especially for small and medium-sized enterprises, many of which would risk not being able to continue their business, and for the equally negative consequences that would be produced for the structures of the national health service”.

And the reasons for this intervention proposed by Maurice Casascocurrent president of the Italian Federation of Sports Doctors, and other parliamentarians call into question the spending capacity of the Regions:

In fact, the provision in question contains provisions to support households and businesses for the purchase of electricity and natural gas, as well as in matters of health and tax obligations;

In particular article 8 intervenes in the field of health payback by allocating 1,085 million euros in order to prevent and reduce the high rate of disputes between companies and regions regarding the amounts that the former should pay in relation to the years 2015, 2016, 2017 and 2018;

The so said payback mechanism was introduced with article 15, paragraph 14, first sentence, of the decree-law of 6 July 2012, n. 95, which provides for a maximum limit to the purchase of outpatient and hospital healthcare services from accredited private subjects currently equal – due to the redetermination made by article 45 paragraph 1-ter, of the decree-law n. 124 of 2019 – at the value of the final expenditure in 2011;

as a result of this regulatory provision, the regions have seen their power to plan the purchase of services from accredited structures limited; the latter, in turn, had to suffer a limit to their ability to provide services, regardless of regional needs;

during the pandemic, the legislator intervened several times in express derogation from the aforementioned spending limit, demonstrating that this mechanism causes a block on services to the detriment of citizens’ health;

the health crisis has had and continues to have disruptive effects on public health and on accessibility to patient care: the cyclical suspension of services considered deferrable and non-urgent has exacerbated serious phenomena – low therapeutic adherence, waiting lists, non-passive mobility physiological, renunciation of treatments – which were already afflicting the National Health Service;

albeit in recent years the National Health Fund has increased significantly, this increase has not produced any effect on the purchases of services from accredited private individuals, as instead happened for pharmaceutical expenditure for which the increases in the Fund, introduced during the pandemic emergency by the various decree laws adopted, have percentage impact, increasing, on the ceilings foreseen for it; conversely, the “ceiling” imposed on the private law component of the National Health Service is anchored to a historical fact, which has remained practically unchanged;

moreover, exceeding the ceiling was requested by the Health Commission of the Conference of the Regions and Autonomous Provinces of Trento and Bolzano in the document sent to the Ministry of Health and released in the press on Monday 7 November 2022, which reads: «These spending ceilings were defined in 2012 and are no longer compatible with the current phase of managing the COVID emergency -19, recovery of health services postponed during the pandemic, implementation of qualification measures and consolidation of the National Health Service. These activities, in fact, involve expansionary health care spending policies which, given the difficulties of having the necessary human resources, require the involvement of accredited private providers”;

Furthermore, as demonstrated by the intervention made with article 8 of the decree in question, the Payback mechanism puts a large number of small and medium-sized Italian companies that produce sanitary devices in great difficulty.