Public healthcare: initial data from the National Platform on Waiting Lists

(by Gianmaria Olmastroni, Gilberto Turati)

A national portal has been online for a few days, collecting official data on waiting times for diagnostic appointments and specialist tests for the first months of 2025. These data appear to show that the National Health Service (NHS) meets the maximum waiting times (established based on urgency) for only half of its services. For the other half, the situation is critical: for emergency services, the percentage of services provided on time reaches 75% for only a few tests and appointments; for less urgent services, almost none reach this threshold. The data provided by the portal is very limited: in addition to not providing information on the maximum waiting times recorded, it only displays data at the national level, not regional or individual facility levels, making it of little use to the public.

The activation of the portal is one of the measures envisaged in a broad decree last summer aimed at reducing waiting lists. Among the other measures envisaged, the establishment of a national body to oversee the provision of services and the regional list management system was approved after a lengthy process, with the possibility of replacing them in the event of persistent irregularities. The inclusion of all providers in the Single Booking Center (CUP) and the exceeding of spending caps for healthcare personnel remain unmet.

In Italy, as in other countries, waiting times for healthcare services can be very long. In 2024, 6.8% of Italians reported having forgone needed diagnostic visits or specialist tests due to long waiting lists. This percentage has grown significantly in recent years (+4 percentage points compared to 2019 and +2.3 compared to 2023). In part, the lengthening waiting lists may be a natural consequence of the pandemic, which has postponed many services, inflating demand in subsequent years. In part, there are structural difficulties in managing demand and therefore distinguishing between appropriate and inappropriate services.

Last summer, the government passed a measure explicitly aimed at reducing waiting times. The decree contains several measures, including the establishment of an online "National Waiting List Platform," aimed at standardizing regional data and informing citizens about waiting times for the necessary tests or visits. One of the problems is the lack of information and transparency regarding waiting times: only a few regions publish the data on their websites, and these are inconsistent.

An initial version of the Platform was published on the website of Agenas, the Regional Health Services Agency, on June 25, 2025, approximately one year after the decree was approved—a long time considering the urgency of the measure. This note describes the waiting list data available on the Platform, the critical issues with the portal, and the implementation status of the other measures envisaged by the decree.

The data

An initial observation regarding the data available on the Platform is that, although the data is transmitted by the regions, it is only available at the national level. Since it is not possible to consult waiting times at specific facilities, or at least at the local or regional level, the Platform is still of limited use to the public. Future versions with more granular data are planned, but it is unclear when they will be available. For each visit or test, three values are currently provided: the number of days within which 25% of services are performed, the number of days within which half of them (therefore the median waiting time), and the number of days within which 75% of services are performed. The portal, in addition to using statistical and technical language that is unclear to the public, does not indicate maximum waiting times; another serious shortcoming, given the objective of transparency.

Below, we report data on the ten most common visits (Table 1) and twenty tests (Table 2), expressed as an average for the first five months of 2025, distinguishing services by four priority classes, from most urgent to least urgent. For example, in a first urological visit (last row of Table 1) with maximum urgency (first three columns), 25% of services are performed on the same day (0 days), 50% within two days, and 75% within four days.

Are the maximum waiting times for each category being respected? For the most urgent procedures, this should be three days. In nine of the ten most common visits, this limit is met at least half the time. However, only in four of these visits does the on-time booking rate reach 75%. For tests, in 19 out of 20 of the most common ones, at least half of the procedures are completed on time, but in only eight cases is this the case for three-quarters of the bookings. The most critical situation concerns colonoscopy, for which the three-day limit is virtually never met: half of the patients wait more than a month (44 days), and, considering May alone, for one in four visits the wait is at least 190 days.

For the second category of emergency, where the visit or exam should be performed within 10 days, the situation worsens. Colonoscopy aside, at least half of the appointments are made on time, both for visits and exams. However, for no visit or exam (except for chest X-rays) are the deadlines met in at least three out of four cases (i.e., 75% of appointments). Furthermore, for visits, waiting times often exceed 20 days, which is double the maximum allowed.

Regarding the "low urgency" category, for all the most common tests, except for colonoscopy, at least half of the procedures fall within the 60-day maximum, but only seven out of 20 meet the deadlines at least 75% of the time. For visits, for which the limit is 30 days, the situation worsens: only in two cases (orthopedic and rehabilitation visits) are at least half of the appointments met the deadlines, while in no case does the percentage of visits on time reach 75%. The longest waits are recorded for dermatology, ophthalmology, and geriatric visits, with peaks that in some cases even exceed 170 days.

The picture for "non-urgent" services is similar: for all tests (again excluding colonoscopy), the median wait time is within the 120-day limit, but only 75% of appointments meet the deadline. All ten appointments meet the deadline for at least half of the patients, but only three out of four appointments meet the deadline.

The state of implementation of the decree

The other measures envisaged by the law on waiting lists required a total of six implementing decrees, two of which have yet to be adopted and four of which have been published. All of the published decrees were adopted more than four months after the scheduled deadline.

Two of the published documents aim to ensure the Platform's consistency with regional data and other health statistical flows, while one defines an action plan for health infrastructure investments within the framework of European cohesion policies.

The most recently adopted decree is the most significant and challenging, as it defines regional autonomy over the prerogatives of the central government. It establishes a National Body to monitor and control the provision of healthcare services and the proper functioning of the waiting list management system. The Body has the power to conduct inspections of regional healthcare, and the regions are required to submit information to it regarding the performance of services. If persistent irregularities are detected, the Body can replace the regions in managing the problem, implementing a sort of commissionership. For example, one well-known irregularity is the closing of reservations, which is prohibited by multiple laws.

The agreement between the state and the regions on the modalities and timing of the Agency's intervention, necessary for its implementation, was reached only on June 12, approximately a year after the law's publication. The implementing decree provides that, following the first report of persistent irregularities, the regions have up to four months to submit observations and resolve the problem independently. If no resolution is achieved, the Agency will take over the management of the issue.

Two central measures of the law remain unimplemented, namely:

• Activation of a digital system to optimize booking management and, above all, the inclusion of all operators in the regional Single Booking Center (CUP), so that the schedules of contracted private operators coincide with those of the CUP. For the former, a decree from the Ministry of Health containing the technical guidelines is required; for the latter, the regions must actually implement the system. Lombardy appears to be the only region to have taken action: according to Councilor Bertolaso, however, the centralized system should be operational by the end of 2026.

• The repeal of the spending cap on healthcare personnel and the introduction of a method for determining expenditure based on a three-year personnel needs plan. The methodology for determining the needs is delegated to one or more decrees, which have no specific expiration date and of which there is no record. In the absence of these decrees, current legislation continues to apply: each year, the spending limit for healthcare personnel consists of the previous year's expenditure plus a 10% increase in the regional healthcare fund compared to the previous year.

Conclusions

The publication of the Waiting List Platform is a first step towards transparency and information availability for citizens. In its current, still nascent state, it is of little use to citizens because it does not provide specific data by region and facility. The healthcare system respects the maximum waiting times for approximately half of services. For the other half, the situation is complex: among emergency services, the percentage of services provided on time reaches 75% for only six out of ten of the most common visits and for eight out of 20 of the most common tests; among less urgent services, almost no services meet this threshold. The agreement between the State and the Regions on the establishment of the National Verification and Control Body is, at least on paper, a sign of the government's attention to the issue of waiting lists. It remains to be seen how it is implemented in practice and to understand the real boundaries between what the State and the Regions can actually do.