(AGI) - Rome, Aug. 30. – The observations of the Regions on Minister Balduzzi's 'decree', put in black and white on the document drawn up by the Health Commission, are all cuts, substitutions and reformulations. But reading to the end we also find 5 articles added to the 27 designed by the ministry. The first striking cut concerns article 6 on the 'National program for non-self-sufficiency': "Crash the entire article", write the Regions, "Motivation: lack of resources; overlapping of competences and violation of Title V of the Constitution". Also eliminated was the entire paragraph 9 of article 11 ('Provisions on the sale of tobacco products, beverages and preventive measures to combat addiction to pathological gambling'), the one concerning the obligation of specialist medical-sports certification. But let's start from the beginning: in the introduction, the Health Commission of the Conference of the Regions provides "detailed assessments of each article with the strong hope that they will be accepted in full". The proposals – we read – are made in the spirit of "loyal collaboration between institutional subjects who, on the basis of the constitutional provision, have concurrent responsibilities in the matters examined". In general terms "the absolute need is underlined for adequate economic coverage to be provided for all the measures which, directly or indirectly, provide for additional costs for the NHS" and it is made clear: "No additional resource can fall on the Regions". The Commission underlines "that the uncertainties and concerns that have led the Conference of Regions to consider the common elaboration of the new Pact for Health unfeasible without changing the forecasts of the very heavy cuts of the National Health Fund for 2013 and 2014" and underline that "with the Spending Review decree the situation has further worsened, not only for the years in question but also for 2015". In the Regions' observations, article 1 of the maxi-decree on healthcare ('Rules for the rationalization of healthcare and healthcare activities') is entirely replaced and practically doubled in length with a sequence of principles and small chapters that go as far as the letter 'p'. In article 2 a first addition reads: "in paragraph 1 letter b) after the words: '…other public entities' add 'and private entities'". Article 2 concerns the 'Fundamental principles on the exercise of the intramural freelance activity' and specifically the regions and autonomous provinces of Trento and Bolzano (the matter is the agreements for external, company and multidisciplinary outpatient clinic spaces, for the exercise of both institutional and intramural freelance activities). The second and final addition concerns "further modalities and criteria for the exercise of the free profession within and outside the walls" by health service personnel "while ensuring that the transitional phase in the use of professional offices by health managers is overcome". In this case, "the rules referred to in this article cease to have effect upon entry into force of the regional provisions".
Important modifications - essentially additions - then arrive on article 14, the one on the 'Patent protection of drugs': "from the expiry date of the patent, drugs reimbursed by the NHS, in the absence of the marketing of the corresponding equivalent drug, the pharmaceutical company is required to
