Waiting lists, new services, rare diseases and assisted procreation: this is how healthcare will change with the new criteria (Lea)

From highly technological services such as hadrontherapy or recent technology such as enteroscopy with an ingestible microcamera and stereotactic radiotherapy to IT and communication aids, including eye communicators and “adapted keyboards” for people with very serious disabilities, hearing aids to digital technology, from domotic equipment and control sensors, to advanced technology artificial limbs and voice recognition and gaze pointing systems. Plus an extension of the list of free vaccines. With the new Lea, the essential levels of assistance that must be guaranteed throughout the national territory, expected for over twenty years, our NHS is trying to renew itself. Waiting lists and underfunding permitting. The decree that updates them will be approved today by the State-Regions Conference to then be published in the Official Gazette, but controversy immediately arose on medically assisted procreation. According to the Luca Coscioni Association, the ministerial decree that includes it in the Lea, rather than remedying the existing defaults and inequalities, will make access to treatment even more discriminatory. First of all because the reimbursement of 1,360 euros, without even specifying whether it refers to homologous or heterologous, is half of the 2,700 euros that the table of the same Ministry of Health set up on the Pma had considered to be the fair rate. Furthermore, there is no indication of the effective financial coverage for each phase of the medically assisted procreation procedure. Finally, according to the Coscioni Association, the document excludes pre-implantation diagnostic investigations on the embryo before transfer into the uterus (an examination that can avoid the risk of transmitting the genetic disease to one’s own child) and does not provide refunds for gamete donors. Omissions that would limit the application of techniques lawful in Italy, which are still not provided by the NHS but only at the expense of the regional health system, with enormous territorial differences. The result is a strong inequality in access to care and respect for the right to health for all couples who need it and who risk fueling the phenomenon of so-called “procreative tourism”.

But let’s see the other innovations introduced by the new Leas.

Outpatient specialist

The new nomenclature that replaces the 20-year old one includes technologically advanced performances and eliminating the now obsolete ones and:
– clearly identifies all the medically assisted procreation (MAP) services that will be provided at the expense of the National Health Service (until now provided only in hospitalization);
– profoundly revises the list of genetic services and, for each individual service, refers to a detailed list of pathologies for which investigation of a specific number of genes is necessary;
– introduces services of very high technological content (hadrontherapy) or of recent technology (enteroscopy with ingestible microcamera, stereotactic radiotherapy).

prosthetics

The new nomenclature that replaces the 17-year old one will allow, among other things, to prescribe:

– IT and communication aids (including eye communicators and keyboards adapted for people with very serious disabilities)
– digital technology hearing aids; – home automation equipment and command and control sensors for environments (alarm and remote assistance);
– cutlery and furnishings adapted for motor disabilities, stretcher adapted for the shower, four-wheeled scooters, wheelchairs with verticalisation system, wheelchairs for large and complex disabilities, fixed and bathtub lifters, support systems in the bathroom ( handles and armrests), stairlift trolleys for interiors;
– advanced technology artificial limbs and voice recognition and gaze pointing systems.

Vaccines

New free vaccinations are introduced, also exempt from co-payments, already provided for in the 2017-19 National Vaccine Plan: meningococcus B, rotavirus and chickenpox in newborns; HPV in 11-year-old males;
tetravalent meningococcus ACWY135 and polio booster with IPV in adolescents;
pneumococcus and Zoster in 65-year-olds vaccinations for people at risk of all ages.

Rare diseases

The provision provides for a substantial expansion of the list of rare diseases (supplied under an exemption regime), achieved through the inclusion of more than 110 new entities among single rare diseases and groups of diseases. Some of the new rare diseases:
– sarcoidosis;
– progressive systemic sclerosis; – myasthenia gravis;
– multiple endocrine neoplasm syndromes; – congenital hyperinsulinism;
– peroxisomal diseases;
– congenital deficiency syndromes of creatine; – chronic primary autoimmune platelet disorders; – idiopathic eosinophilic myositis.
Chronic diseases

Six new exempt diseases are introduced: 1) thalidomide syndrome, 2) chronic osteomyelitis, 3) chronic kidney disease, 4) autosomal dominant polycystic kidney disease, 5) endometriosis in “moderate” and “severe” clinical stages, 6) chronic obstructive pulmonary disease in “moderate”, “severe” and “very severe” clinical stages;
– some pathologies already exempt as rare diseases are moved among the chronic diseases, such as: 1) celiac disease, 2) Down syndrome, 3) s. Klinefelter, 4) undifferentiated connective tissue.
Newborn screening

Introduction of newborn screening for congenital deafness and congenital cataract; extension to all newborns of the extended newborn screening for hereditary metabolic diseases.
Endometriosis

The inclusion of endometriosis in the list of chronic and disabling pathologies is envisaged, in the “moderate” and “severe” clinical stages. Consequently, patients are recognized as having the right to benefit from certain specialist check-up services without exemption. Approximately 300,000 exemptions are estimated.
Celiac disease

It becomes, from a rare disease, a chronic disease. This is because the diagnostic process of this pathology is not, to date, tortuous, long and onerous as it happens for rare patients.
– all specialist outpatient services included in the Lea, useful for monitoring the disease and preventing complications and any aggravations, are kept exempt. As with all chronic diseases, a disease certificate drawn up by a specialist of the National Health Service is sufficient to obtain the new exemption certificate.
– The discipline of granting food to celiacs is maintained.
Autism

The new draft decree implements law no. 134 of 2015, which provides for the updating of the essential levels of assistance for the early diagnosis, care and individualized treatment of autism spectrum disorders. The news are:
– quality of care: the use of methods and tools based on the most advanced scientific evidence available is envisaged in the diagnosis, treatment and treatment process; – integration into social life: the reintegration and reintegration of the minor into social life is promoted through the connection of health care with educational institutions and through interventions on the formal and informal social network – involvement of the family: attention is paid to active participation of the family, with support interventions, training and orientation dedicated to it and active involvement in the therapeutic process