Focus Paper no. 4 / 8 July 2016

Download PDFMeasures to ensure the appropriateness of specialist medical care


The Focus addresses the issue of the appropriateness of medical treatment in general and analyses the law recently enacted to enhance specialist medical care (Law 125/2015, ratifying Decree Law 78/2015), tracing the vicissitudes of its implementation and shining a light on its problems. The concept of inappropriateness is also examined with the presentation of a series of examples; their causes and possible remedies are considered, drawing on the experience of other countries as well. The Focus also analyses the bill on the professional liability of health workers under examination in Parliament, which among other things is intended to counter the practice of so-called “defensive medicine”, considered one of the main causes of inappropriate treatment. The bill assigns a central role to the recommendations contained in specific guidelines, which would be developed by scientific associations in the medical field.


The implementation of Decree Law 78/2015 – which provided for possible penalties for patients (exclusion from the public healthcare system) and physicians (financial penalties) – was afflicted by a number of problems and delays. These difficulties were in part the consequence of the urgent need to generate significant immediate savings, which prompted the addition of the appropriateness and rationing objectives. Moreover, the importance of ensuring the cooperation and involvement of the medical profession does not appear to have been given adequate consideration. The debate over the nature and methodology of defining the guidelines has been wide-ranging and could have repercussions on the final version of the professional liability bill.


The direction to be taken seems to be the progressive formation of a scientific-professional consensus on treatment approaches based on reliable scientific studies and informing the public on the inherent uncertainty involved in clinical decisions. It also appears preferable for the coordination of the drafting of the guidelines and the associated financing be entrusted to public entities who are already involved with the issue, partly in view of the need to contain conflicts of interest.


Text of document (in Italian)