Essential Levels of Care (LEA)
The Essential Levels of Care (LEA) include all activities, services and care that the National Health Service is required to guarantee to all citizens, free or by paying a fee (ticket). In addition to art. 32 of the Constitution, the establishment law of the SSN in 1978 introduced for the first time the concept of "levels of health care to be guaranteed to all citizens". The LEA have been defined at national level with the Decree of the President of the Council of Ministers of 29 November 2001. Individual Regions may use their own resources to guarantee services and care in addition to those included in the LEA.
Indice
Services included in the LEA
The service and care included in the LEA are divided into three macro areas, depending on the type of care [1]:
Collective health care in life and working environment
It includes activities and services which specifically concern:
- prophylaxis of infectious and parasitic diseases;
- protection of the community and individuals against the risks associated with living environments, also regarding the health effects of environmental pollutants;
- protection of the community and individuals against accident and health risks associated with the workplace;
- veterinary public health care;
- health and hygiene protection of food;
- nutritional surveillance and prevention;
- prevention activities for persons (mandatory and recommended vaccinations, early diagnosis programs);
- medical-legal service.
District Care
It includes all activities and services that are in the territory and in particular concern the following areas:
- basic health care (basic medicine and paediatrics service as outpatient and home care, continuous assistance service at night and during holidays, medical service for tourists determined by the Region);
- activities of local health emergency;
- pharmaceutical care provided through local pharmacies;
- supplementary care (supply of dietary foods for special categories, provision of health facilities to patients with diabetes mellitus);
- specialized outpatient care (specialist visits, therapeutic and rehabilitation services, diagnostic and laboratory tests);
- prosthetic care (provision of prosthetics and aids for people with physical, mental and sensory disabilities);
- outpatient and home community care (home care, family planning clinics, mental health services, rehabilitation services for the disabled, services for people addicted to drugs or psychotropic substances or alcohol, home care for patients in the terminal stage, care to people with HIV infection);
- residential and semi-residential community care (homes and day centers for elderly dependents, therapeutic communities and day centers for people addicted to drugs or psychotropic substances or alcohol, therapeutic communities and day centers for people with psychiatric problems, residences and day centers for the rehabilitation of disabled people, hospice for patients in the terminal phase, residences for people with HIV infection);
- thermal spa care (hydrothermal treatment cycles for patients with certain medical conditions).
Hospital care
In particular, it includes:
- emergency room, ordinary inpatient, day hospital, day surgery, hospital activities at home (based on organizational models established by the Regions), rehabilitation, long-term care, collection, processing, control and distribution of blood components and transfusion services;
- activities of collection, storage and distribution of tissues;
- activities of transplant of organs and tissues.
These three macro areas include specific care for particular categories of citizens who are in special conditions. These categories are:
- disabled;
- patients with rare diseases and cystic fibrosis;
- patients with chronic kidney disease on dialysis;
- patients with diabetes mellitus;
- people with Hansen's disease;
- citizens resident in Italy authorized to treatment abroad.
Services partially excluded by the LEA
The services partially excluded by the LEA are those that may be provided by the SSN only in the presence of specific clinical indications [2]:
- dental care
- bone densitometry
- physical medicine and outpatient rehabilitation
- refractive surgery with excimer laser
Services totally excluded by the LEA
Services totally excluded by the LEA are those that cannot be provided by the SSN and therefore completely borne by citizens. The law, in fact, clarifies that, in general, cannot be included in the LEA the facilities and services that:
- do not meet health care needs protected under the principles of the SSN;
- do not have, according to available scientific evidence, demonstrable effectiveness;
- are used for subjects whose clinical conditions do not correspond to the recommended practices (do not meet the principle of clinic appropriateness);
- do not meet the principle of cost-effectiveness in the use of resources with respect to other forms of care that meet the same needs [3].
Specifically, the following are excluded from the LEA and cannot be performed by the SSN [4]:
- cosmetic surgery not resulting from an accident, illness or congenital malformations;
- male ritual circumcision (non-therapeutic);
- non-conventional medicine;
- vaccinations that are not mandatory when travelling abroad;
- medical certificates that do not meet the protection of collective health, even when required by law;
- some services of physical medicine and outpatient rehabilitation.
Notes
- ↑ Annex 1 to the DPCM 29 November 2001Definition of essential levels of assistance Last access 23/04/2015.
- ↑ [ Annex 2 to the DPCM 29 November 2001 Definition of essential levels of assistance Last access 23/04/2015.
- ↑ Legge 502 del 1992 art 1 comma 7Last access 23/04/2014.
- ↑ Definition of essential levels of assistance Last access 23/04/2015.
