It is a fact that the Health Fund is the most important item of expenditure of the Regions: on average 49-50% of the total expenditure of each single region, thus constituting the most important source for obtaining local political consensus, albeit within limits imposed by the law which established the National Health Service. In fact, the so-called First Republic was running when at the end of 1978 the law of 23 December 1978, n. 833 which established the national health service. And so On December 23rd of this year almost half a century will have passed since the entry into force of this law whose incipit is still today the following: "The Republic protects health as a fundamental right of the individual and in the interest of the community through the national health service. (…) The national health service is made up of the complex of functions, structures, services and activities intended for the promotion, maintenance and recovery of the physical and mental health of the entire population without distinction of individual or social conditions and according to methods which ensure the equality of citizens in relation to the service. The implementation of the national health service is the responsibility of the state and the regions".
Next year, when the populist winners of the constitutional referendum which reduced the number of parliamentarians will be called, after the first step, to keep the promises then guaranteed for the consequent adjustment of the legislative and constitutional norms, a reflection by them should also be unavoidable on the problem of the State-Regions relationship in the area of health. Problem made inescapable by the indecorous show of inconclusive debates offered in these months dominated by the pandemic.
More than half a century after the establishment of the Health Service the next reflection should concern not only what has happened that was unacceptable in the most diverse regions in the course of this last year of the pandemic: in fact, it would only be a short-term perspective looking backwards. Instead, from a long-term perspective as required by health protection, the state and regional political class should above all question whether the State-Regions organizational model has guaranteed and implemented throughout the national territory the fundamental objective of the 1978 law before recalled. Bearing in mind that the protection of health is a collective good that has the same rank of importance as national defence, especially in the field of prevention.
Since the per capita expenditure disbursed in the various regions fluctuates with respect to the national average (approximately 1850 euros) between 1500 euros and 2700 euros (see graph) one must ask whether such differences are due to autonomous organizational models and to the most diverse combinations of public health and conventional health care. It follows that regional autonomy does not appear to have consequently pursued and implemented uniform health protection regardless of territorial location, even in the absence of long-term planning that went beyond mere hospitalization to the detriment of prevention.
Indeed, between the discharge of political responsibilities and the search for immediate consensus that excludes necessarily long-term prevention, regional autonomy has shown serious defects and numerous organizational problems in the functioning of the National Health Service disarticulated in too many decision-making forums: put under stress precisely when he has to pursue the objective of fighting a virus that has no territorial borders. It is a model that combines decentralized political decisions and responsibilities (the Regions), seeking immediate consensus in a very short-term view of their citizens, on an organizational level, with central political decisions and responsibilities (the State). The latter to the dutiful search for the long-term consensus of his own work. These are issues which, beyond the claims of the regions, impose themselves on the reflection of the government which will also have to deal with ordinary laws such as the law establishing the National Health Service, the organizational reorganization leaving the Regions the function of programming the National Health Plan, taking away the management, in order to achieve, according to the best organizational practices, territorial equality of the effectiveness of national health care and prevention.
