BARI – On June 30, AIFA will determine the definitive value of the payback, the discount that suppliers must return to the Regions. Once this is done, the 2023 pharmaceutical spending data will be definitive. And they will be used to apply regional law 7/2022, which provides for the dismissal of the general directors of local health authorities in the event of failure to comply with the ceilings. Starting, in all likelihood, a rotation.
There will therefore be no exceptions. If – as appears possible – the regional law is modified to take into account some critical issues, the changes will be valid from the current year. But for 2023, according to a report that the Health department is preparing for governor Michele Emiliano, the rule desired by regional councilor Fabiano Amati will have to be applied as it is written. And it will lead to the dismissal of all the general directors in office, including those of the hospital companies who have tried to pass on part of the costs to the local health authorities.
In fact, the AIFA data updated in November say that all local health authorities have respected the ceiling on affiliated pharmaceutical expenditure, i.e. that made through pharmacies. However, none of them respected the limit of direct pharmaceutical expenditure, that for medicines administered in hospital, a ceiling which has always been exceeded (since it was identified by national law, without sanctions) by all Italian regions. In this sense we read the criticisms of some political forces, including the Democratic Party, of law 7 which the Dems also voted for at the time. In May, numerous members of the majority filed a proposal to ask for its repeal.
In the period January-November 2023, the Apulian local health authorities spent 2.7 million euros less than the ceiling on affiliated pharmaceuticals, with a slowing trend compared to the first seven months of the year when instead spending was growing (and outside the target ) compared to the previous 12 months. On the hospital side, however, the deviation from the ceiling is 283 million. Since law 7 of Amati makes no differences, it follows that the general directors must all be declared dismissed, with the exception of Antonio Sanguedolce who in the meantime passed from the Bari Local Health Authority to the Bari Polyclinic.
The forfeiture procedure is not automatic, but involves a guarantee process which involves the request for counter-deductions from the interested parties. It will therefore take a few months. Among the possible consequences there is a negative impact on the performance bonus that is due to local health authority managers, but it should not lead to cancellation from the register of eligible persons. In short, it means that immediately afterwards – or perhaps at the same time – the Region will be able to start the procedures for appointing new general managers to proceed with the rotation of positions.
Law 7 is not the only one that is causing headaches these days. In fact, on the table of governor Emiliano there is also law 13 of April, the one which assigns the management of all competitions to the Aress agency and which has been challenged by the government for (macroscopic) unconstitutionality. The problem is that from 1 July the local health authorities should start the new competitions: according to the now contested law, the Aress (which has neither the staff nor the skills) should be in charge of them, or one of the other local health authorities. This second alternative also ended up in the sights of Palazzo Chigi.
The Region is therefore at a crossroads, knowing also that that law is part of the package of commitments made by Emiliano with Amati to obtain the favorable vote of Action for Confidence. In fact, it could apply it anyway, with the mathematical certainty of being unconstitutional (the competitions must be run by a healthcare company, Aress is not). Or it could do as it has done up to now, unpacking the competitions (by category) into the different local health authorities. In either case, delays and appeals are inevitable.
