Presentation (CTI)

OBJECTIVES: Italy has recently introduced regulations to reorganize its healthcare system toward more efficient, resource-saving models while maintaining the same level of clinical appropriateness. Following COVID-19, territorial healthcare has been theoretically strengthened through proximity networks (Community Hospitals, Care Centers), home care, and telemedicine. November 2024 Tariff Decree, adopted regionally, promotes shifting many inpatient services to outpatient care, recognizing the pivotal role of technological innovation in driving this transition.This study reviews recent legislation and uses case studies to show how technology enables care delivery changes.
METHODS: The analysis reviewed recent National (DM 77/2022, Tariff Decree 25/11/2024) and Regional (DGR Puglia 1863/2024, DGR Lombardia 3036/2024) legislation related to hospital care, territorial services, and National Health Benefits Basket.
RESULTS: The analyzed legislative acts identified several surgical procedures now included in the national outpatient tariff nomenclature, reflecting technological advances enabling outpatient treatment. Two cases were examined: hernia repair and Implantable Loop Recorder (ILR) implantation for continuous cardiac monitoring. Outpatient hernia repairs—inguinal, femoral, and umbilical, with or without prosthetics, both direct and indirect—are now permitted. Inpatient care is discouraged by classifying related DRGs (160, 162) as high-risk inappropriate due to outpatient feasibility with equivalent outcomes. Regional caps on inpatient hernia repairs reduce reimbursements beyond set limits. For ILR implantation, the national tariff outpatient fee sometimes fails to cover costs; Lombardy introduced a specific regional tariff, and Puglia incentivizes outpatient ILR via tailored Complex and Coordinated Ambulatory Pathways (PACC).
CONCLUSIONS: The adoption of resource-efficient care models, where clinically appropriate, enhances healthcare system capacity, thereby enabling the treatment of a greater number of patients with existing resources and contributing to the reduction of waiting lists. The synergy of technological innovation, regulatory reforms, and regional reorganization offers a concrete opportunity to guide Italy’s National Health Service toward more sustainable and efficient care.