European Union of Private Hospitals

Public-private partnership: what future?

Extract from an interview with AIOP (Italian Association of Private Hospitals) President Barbara Cittadini published in Trend Sanità.

What is the situation of the private-law component of the National Health Service?

Article 32 of our Constitution entrusts the fundamental task of protecting the health of individuals to the Republic, which, through the Regions, according to the current allocation of competences, must – or should – guarantee all the services necessary to satisfy the population’s need for care.

This function is, therefore, public: otherwise, it has never been envisaged, nor would it be rational to envisage, that public should be the legal nature of the structures the State uses to perform it.

So true is it that, within the National Health Service, since its original configuration, there have been both public and private structures, the coexistence of which must be read in terms of the best possible articulation of the health supply.

As the association most representative of the private sector of the NHS, therefore, we have always promoted a virtuous synergy between the two components of the system, in order to respond effectively, efficiently and punctually to the population’s treatment needs.

What are the challenges in achieving a true public-private partnership?

The most important lesson of the pandemic has been its management through recourse to the potential of the NHS as a whole, favouring – and not inhibiting – the contribution of the private sector.

The emergency itself made it possible to overcome the ideological and systemic conditioning that had hitherto relegated the private sector to an executory role and, in too many cases, had sacrificed public health protection on the altar of public ownership.

The components of the NHS must enjoy full and equal dignity, notwithstanding their different legal status: there is an urgent need to move beyond the anachronistic and unsuccessful logic of spending caps, which has proved to depotentiate the NHS in its ability to plan to meet care needs.

The spending limits, provided for in Article 15, paragraph 14, of Legislative Decree No. 95 of 6 July 2012, are the expression of an emergency regulation that has indefinitely blocked the possibility of providing services and benefits in greater quantities than those provided in 2011, setting a maximum limit to the purchase of ambulatory and hospital health services from private NHS subjects.

This is one of the most urgent aspects that must be addressed and resolved in order to reduce aggravating phenomena such as waiting lists and dramatic phenomena such as the renunciation of care.

There is criticism today that accredited private and public have different rules (on personnel, spending ceilings, hospital wards) that would favour the private at the expense of the public. In your opinion, is this the case? What do you think should be done to improve it?

Claiming that the private component of the NHS is favoured and privileged is a commonplace, which is detrimental to healthcare as a whole, and denounces a lack of knowledge of how the system works.

It is necessary, in fact, to know the commissioning rules of our NHS: the function of protection is guaranteed by the Regions, which, on behalf of users, purchase healthcare services from public and private accredited structures.

The latter do not choose autonomously either what to provide (type of services) or to what extent (volumes of activity), but can only provide the population with the services and performances requested by the Regions by virtue of a relationship that follows three strongly regulated moments: authorisation, accreditation and contractual agreement.

The regions themselves, in turn, are bound by the aforementioned policy of expenditure ceilings.

If services are missed or delayed and there is a so-called “flight to the private sector”, this is not due to the private component of the NHS but, on the contrary, to the effect of outdated, anachronistic and constitutionally dubious legislation that is squeezing the potential of the system.

Moreover, it is anomalous, to say the least, that when one speaks of a flight to the “pure private sector”, one always forgets to mention that “pure private sector” provided by public facilities, in public spaces, financed with Italian taxpayers’ money through general taxation.

The right to health of individuals and their interest in effective, appropriate, safe and timely care must be protected and guaranteed, without economic and social distinctions or prejudice based on the legal nature of those who provide services on behalf of the National Health Service.