Executive Summary

 

Title: Fiscal Compensation Model for Reducing Healthcare Waiting Lists and Passive Mobility: The Sicilian Pilot Case (2025–2028).

 

Overview: This study introduces an innovative, replicable model that integrates healthcare programming with fiscal policy to reduce waiting lists, passive patient mobility, and health system inefficiencies in the Sicilian Region. It proposes a hybrid public-private framework, incentivizing local authorized and accredited healthcare facilities to absorb unmet demand through a tax credit mechanism linked to the standard LEA (Essential Levels of Care) tariffs.

 

Core Idea: Citizens pay the regular LEA ticket for specialist visits or ambulatory surgery. Private healthcare facilities are reimbursed through a tax credit equivalent to 30% above the LEA tariff, instead of direct regional disbursement. The model features:

• Reduced regional IRPEF (personal income tax) rate at 0.30% (from 1.29%)

• Reduced IRAP (regional production tax) rate at 1.90% (from 3.90%)

• Exclusion of direct healthcare budget increases: financing occurs via tax incentives

• Estimated 20% increase in healthcare employment

• Activation of both authorized and accredited private facilities, expanding the provider network

 

Key Impacts (2026–2028):

• 182,000 specialist procedures outsourced (e.g., cardiology, oncology, diagnostics).

• +20% employment in private health sector, creating ~1,400 new jobs.

• €27M+ in social security contributions from new employment.

• €30M+ in additional IRPEF from salaries and freelance medical services.

• Over €23M in cost savings for the Regional Health System from fewer hospitalizations and complications.

• Break-even by 2026, with a cumulative positive net fiscal balance of €4.6M by 2028.

 

Use Case Examples:

• Cardiology: preventive visits reduce ER admissions and hospitalizations due to acute cardiac events.

• Oncology screening: early diagnosis through local private facilities decreases long-term treatment costs and mortality.

 

Strategic Objectives:

• Drastically reduce waiting times for outpatient procedures.

• Cut passive mobility costs (€241.8M in 2022 alone).

• Retain healthcare expenditure within regional economy.

• Enhance territorial equity and access to timely healthcare.

 

Why It Matters: This approach demonstrates how public health financing can be optimized through smart taxation without increasing central or regional budgets. It aligns fiscal leverage with healthcare priorities, ensures better service for citizens, and stimulates the local economy.

Scalability: The Sicilian model offers a blueprint that could be applied to other regions in Italy or Europe, particularly where disparities in healthcare access and outmigration persist. Its data-driven design and measurable economic benefits make it an ideal pilot for national or EU-level innovation funding.

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Recommendation: We recommend initiating this model in 2025 as a pilot under ministerial supervision, with full deployment by 2026. The project will operate within existing legislative frameworks, using tax leverages to redirect healthcare expenditure more efficiently.

A more detailed technical annex is available upon request, including simulation models, annual provincial breakdowns, and employment projections.

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Dr. Giancarlo Pregadio

April 2025 

 

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