Italian citizens have been waiting for the update of the essential levels of assistance (Leah), or all those services that the Health Service must guarantee to the population, free of charge or through the payment of a copay. Frozen at the previous update of 2001the list of exams, visits and eligible treatments it had been reformed in 2017, but never came into force. TO seven years away, thousands of patients are forced to give up performance to which they would be entitled: procreation medically assisted, specialist outpatient activity for the treatment of disorders fooddiagnosis and monitoring of celiac diseasescreening neonatalhadrontherapy for tumors, IT and communication aids for the disabled, prosthesis advanced for motor disabilities. Everything postponed for another nine months. With a decree signed by Ministry of HealthIn fact, the deadline for the implementation of the new LEAs, scheduled after an initial extension for April 1, 2024, is postponed again to January 2025. Until then, those who can afford it bypass the problem and turn to private healthcare. All the others either give up or are forced to migrate, to be treated far from home. Some regions of the North, in fact, have decided to anticipate the times of the State and, drawing on it to their fundshave been able for years to guarantee part of the performance expected from the 2017 Lea update. And so the gap between North And South in the right to health continues to increase.
Among the people who will suffer the consequences of the slip there are those who suffer from eating disorders (dca), around 4 million Italians (of which 70% are teenagers). Around 4 thousand deaths per year in the age group between 12 and 25 years. “We continue to die from eating disorders. Not for the disease itself but for the severity that the disease reaches when it is not taken care of – explains a ilfattoquotidiano.it Aurora Caporossifounder of the non-profit Animate. L’nervous anorexia, for example, among psychiatric diseases it is the one that has the highest mortality rate, but at the same time it also has a high remission rate. It is a paradox, but it means that if we worked effectively on prevention, many deaths would be avoided.” And this is what the Lea update was for: to give everyone the possibility of a first visit with which to obtain a diagnosis and activate a treatment path. “This postponement penalizes all patients who cannot afford private care, despite this being in all respects a social epidemic.”
Without accessing a center it is not possible to have a diagnosis and begin a healing process. Due to the numerous requests for support and the lack of treatment response, the waiting lists for the centers fluctuate from six to twelve months. A long time during which the pathology can become very serious, even leading to the patient’s death. In January, the Minister of Health Orazio Schillaci had announced that, thanks to the update of the Lea, citizens would have access to 16 new performances of appropriate outpatient specialists for disease monitoring. “We never knew the nature of the exemptions provided. We hope that they concern the first visit and the possibility of accessing the DCA clinics, because families don’t know where to go.” Many, if they have the economic and organizational possibility, are forced to migrate. Real pilgrimages around Italy to care for their loved ones.
“Throughout the Molise there isn’t even a center for eating disorders – comments Caporossi -. But also in regions that are very advanced from this point of view, such as Umbria And Lombardy, the centers are full,” he explains. To guarantee the therapeutic continuity required by these pathologies, some centers are even forced to Change of residence oh break up with by one part of the family, unable to follow the patient away from home. To these critical issues must be added the expenses that families have to bear. To deal with a DCI, you need the professional support of a team – a doctor, a dietician, a psychologist – and huge expenses must be faced for medicines, supplements and psychotropic drugs. “There are exemptions – explains the founder of Animenta -, but currently they only concern some disorders, such as anorexia and bulimia. And in any case the problem remains that to access the exemptions it is necessary to have the diagnosis, and therefore overcome the main obstacle of obtaining the first visit”.
Obtaining adequate care therefore remains a privilege. As it is still access the medically assisted procreation (pma). The postponement of the entry into force of the new LEAs, in fact, has hit hard the hopes of thousands of people who have been waiting to be able to access this service through the Health Service since 2017. Infertility in Italy is a widespread problem: Almost one in five couples 17.5% are affected by it. “People are furious – explains a ilfattoquotidiano.it Antonino Guglielminofounder of Italian Society of Human Reproduction (Siru). In Italy we now have the Virtual Leas. After seven years of slippage, it was thought that the moment had finally arrived, the expectation was very high. Especially for those who live in the South and do not have any type of reproductive assistance. Since last autumn, many couples have been on the waiting list in view of the green light on April 1st. But it all ended up being an April Fool’s joke.”
The situation is worse in the South. In Sicilyexplains Guglielmino, you pay a decidedly high amount to access the pma, even within hospitals. An economic barrier of almost 3 thousand euros which forces many people to give up having children. A relevant topic if you consider that Italy is one of the countries with the worst birth rate in Europe. The updating of the LEAs, on the contrary, would have had an impact on the demographics of the country. Suffice it to say that today the 4.2% of births in Italy occur thanks to medically assisted procreation. “The damage created by these nine months of postponement is significant – explains the founder of Siru -. If there is a pathology in the couple, especially in the woman, which determines a state of infertility, the chances of conception decrease in a potentially decisive way”. According to data released by the Istituto Superiore di Sanità, the average age of women who turn to ART centers he is almost 37 years old. “Studies say that for this age group, between 36 and 37, losing an additional year waiting for the Lea to come into force means lowering the chances of conceiving from 26.6% to 23.4%. A decrease of approximately 12%, considering the percentage variation”, declares Guglielmino.
The regret of the founder of Siru is also fueled by the fact that the introduction of MAP in the LEAs would have had a positive impact on the relationship between doctor and patient. “Once the service was included among the NHS services, the patient would feel protected from possible speculation – he comments -. This is a totally different approach to medicine, especially in light of the fact that a good part of medically assisted procreation centers in recent years have been acquired by financial groups. Thus there is a risk that pma in Italy you just become a business, controlled by people who perhaps live in New York. The entry into force of the Lea could put a brake on this process and reduce the power of private individuals,” he concludes.
