Yesterday 26 June, the III Commission chaired by Mauro Vizzino approved the bill that fully repeals regional law 7 of 2022 on the containment of pharmaceutical spending, which among other things established the forfeiture by law of the general directors of the ASL and healthcare companies in case of failure to comply with the spending limits set annually by the regional council with its own resolution.
The bill, first signed by Democratic Party councilor Filippo Caracciolo – signed by many majority councilors – passed with the abstention of Forza Italia commissioner Massimiliano Di Ciua and the vote against by Action commissioner Sergio Clemente.
What is it about
Pier Luigi Lopalco explained the reasons. “In the opinion of the proponents, law 7 does not achieve the desired objectives of reducing spending but simply shifts the responsibility for an objective impossibility of correctly managing a complex system such as that of pharmaceutical spending onto a scapegoat (the general managers)”.
In support of the repeal, it is highlighted that the excess rate is in line with the national average and that this criticality cannot be directly attributed to the general managers as “the problem of exceeding the spending ceiling lies, to a large extent, in the increase in the cost of medicines and in the Ministry’s failure to adjust the spending ceilings with respect to said increase”. Lopalco explained that the issue cannot be setting a ceiling, tracing it in a linear and “accounting” way, but instead it is necessary to proceed with a “qualification of pharmaceutical expenditure” using pharmaco-economic criteria, which translate into “a savings for the regional health system as a whole while preserving the citizen’s pre-eminent right to health”.
The opposition of Fabiano Amati
Against the repeal of law 7 (of which he was the proponent), councilor Fabiano Amati stigmatized the proposal as an ‘amnesty’, a ‘general manager-saving’ law.
Amati argued that with the repeal tout court the monitoring of pharmaceutical spending will also be canceled but above all, he argued “it goes against the guidelines of the council and of President Emiliano, who annually indicate in a resolution the spending ceilings to be respected”.
In asking for a rethink on the proposal, suggesting its withdrawal for a subsequent discussion also with the regional government, Amati formulated a different hypothesis on the reasons for the spending overrun, highlighting how the most relevant reason is not the increase in costs or productivity of companies, but “the lack of competitions being held by an aggregator centre”.
A lack which, according to him, would have caused a deviation of one billion and 200 thousand euros compared to a total health fund of approximately 8 billion euros.
Amati’s proposal, endorsed by Commissioner Clemente, was rejected by the proponents who anticipated the drafting of a draft law that lends itself to a “more suitable identification of measures aimed at obtaining savings through the qualification of pharmaceutical spending”.
However, councilor Michele Mazzarano, by refusing to withdraw the PDL, highlighted the need for a political reevaluation of the general planning, “keeping in mind the territorial specificities”.
The “no” from Action’s regional councillors
The regional councilors of Azione Fabiano Amati, Sergio Clemente and the group leader Ruggiero Mennea intervened on the matter, having remarked on Wednesday 19 June that the general directors (except for the two of the Polyclinic of Bari and the ASL of Brindisi because they were not in office in the entire year) had been removed from office due to the 2023 direct pharmaceutical expenditure exceeding the limit, as was ascertained by the resolution of the Regional Council approved on Monday 17 June. “It follows that all the acts adopted, starting from 18 June 2023, are to be considered null and void because they were adopted without title. We therefore invite President Emiliano to immediately appoint the commissioners, so as not to leave the local health authorities without government” the appeal made to the Governor.
“The amnesty is passed to the Commission for the directors general who are in breach of the containment of pharmaceutical spending, in an attempt – useless – to keep them in their place, also canceling all the rules on monitoring. And the fact that the attempt is useless derives from the fact that, even if should the proposal be approved by the Council, the forfeiture effects with respect to 2023 have already occurred and the law, therefore, cannot have retroactive value. We have essentially observed a fury for an amnesty, incapable of realizing that the ceilings on pharmaceutical expenditure which, we reiterate, does not affect the quality and quantity of assistance, were established by Emiliano and before that by Palese and Lopalco, with the signing of the technical regularity by dozens of managers.
The bill approved in the Commission, therefore, is in contrast with the fight against waste carried out by the Regional Council, as it eliminates the sanction of the dismissal of the general directors of the local health authorities in the event of non-compliance. In other words, the council speaks and no one listens to it.
Yet we had recently said that the government majority would start from legality and transparency, to the point of even appointing a councilor with this specific competence.
And instead the good initial intent has crashed into the first curve, because it is more important to keep the CEOs in the saddle, even if they are in default, rather than saving and directing resources towards greater healthcare services or more cutting-edge therapeutic remedies, such as the Car-Ts, to treat very serious diseases.
But it doesn’t end here and we will fight in the chamber, to defend not so much the law on forfeiture but the resolutions on spending containment approved by the Regional Council and most recently the 848 of 2024″.
Spending ceiling variance
In 2023 the overall regional deviation was equal to 191,394,450 euros, compared to a ceiling of 687,706,916 euros.
Specifically, as regards the ASL Bari, on a ceiling of 167,387,863, there was an expense of 226,527,321. Therefore a difference of 59,139,457 euros.
For the ASL Brindisi on a ceiling of 71,659. 061, an expense of 95,959,070 and, therefore, a deviation of 24,300,009.
For the ASL Bat on a ceiling of 60,793,291, an expense of 79,548,144. The difference was 18,754,853 euros.
For the ASL Foggia, on a ceiling of 74,478,659 and spending of 89,302,989, there was a difference of 14,824,330 euros
For the ASL Lecce on a ceiling of 128,188,569 with spending of 167,869,690, a difference of 39,681,121 euros.
For the Local Health Authority of Taranto on a ceiling of 94,009,535, an expense of 123,095,669. Therefore a difference of 29,086,134 euros.
For the Polyclinic of Bari, on a ceiling of 51,371,707 and an expense of 53,058,188, there was a deviation of 1,686,481 euros.
For the Policlinico Riuniti, compared to the ceiling of 18,017,921 and an expense of 20,411,478, there was a deviation of 2,393,557 euros.
And again, as regards the IRCCS John Paul II, the difference of 507,349 euros comes from an expense of 17,837,563 compared to a ceiling of 17,330,214.
For Irccs De Bellis, on a ceiling of 4,470,095 euros and an expense of 5,491,254, there was a deviation of 1,021,159 euros.
Emiliano: “Directors resign from office”
Yet at the beginning of May it was Michele Emiliano who confirmed that the CEOs of the Apulian local health authorities who had exceeded the pharmaceutical spending limit would be removed from office: “The law we have approved is clear: the general directors of the local health authorities who have breached the pharmaceutical spending limit will lose their office, therefore they will be rotated, without any blame, but evidently as an element of stimulus in the realization of the objectives that the regional council and the Department they indicated. We also told all the managers of the Health Department that they no longer have to mediate with a very complex system like that of healthcare, they must achieve the objectives assigned. Perhaps this will bring unpopularity, but citizens’ rights come first. There is a constitutional obligation to protect people’s health, not to protect positions of power within healthcare”
