Review of waiting times policies. Country case studies: Italy

In Italy, waiting time is a critical issue for out-patient specialist care and diagnostic services, and it is being tackled by national plans issued in the last decade. Most regions improved patients’ access through better information on waiting times, process re-engineering and the creation of unified booking centres. In addition, important prioritisation criteria have been piloted to manage waiting time based on clinical criteria and professional judgment (for example, the Homogenous Waiting Groups pilots). However, actual policies, including the implementation of national legislation, vary across the regions, with some of them very active and others often lagging behind. Policies on co-payments, intramoenia dual practice and voluntary insurance also have substantial effects on waiting time. National and regional co- payments have likely reduced waiting time via the reduction of demand for national health services, but rather broad exemption criteria have limited their effect on the more affluent and healthier part of the population. The expansion of intramoenia dual practice and the promotion of additional private health insurance could undermine access to the NHS basic health care package: the former may encourage doctors to build up long lists in their public practices so as to maintain demand for their private practice, whereas the latter may worsen equity of access to the NHS services.