Context
In July 2024 Italy enacted Law 107/2024 to curb persistently long waiting times for publicly funded health services. This urgent‐measures legislation (aligned with the health component of the Recovery and Resilience Plan) mandates a new Piattaforma Nazionale delle Liste di Attesa (PNLA – National Platform for Waiting Lists), to be hosted and managed by AGENAS (the National Agency for Regional Health Services). Its stated aims are to interconnect the regional booking systems with a national portal, thereby centralizing data on waiting times and appointments. At the national level the PNLA is to provide real‐time monitoring of key metrics – such as waiting times by priority class and available appointment slots under both the public system (the National Health Service (NHS) and private accredited providers which are contracted to provide services under the NHS. By aggregating this information, the platform is intended to make system-wide trends visible: it permits a clear and detailed picture of healthcare services across all regions, supporting targeted planning.
Objectives of the PNLA
Officials emphasize four strategic objectives:
- to monitor and manage waiting lists (collecting comprehensive regional data);
- to guarantee transparency (through a national transparency portal giving citizens real-time access to wait-time indicators);
- to support decision-making (enabling administrators to plan resources based on data); and
- ultimately to reduce waiting times by improving efficiency and central coordination.
Technical infrastructure, data integrity and stakeholder access
The PNLA is designed as an advanced interoperability hub linking existing regional systems into a unified framework. According to official guidelines, it uses international data standards to ensure secure, reliable exchange with each region’s booking systems. Data flows from regional servers into a central node; each region must continuously feed the platform with up-to-date information on schedules, completed bookings and appointments. The system is explicitly non‐personalized: it does not process individual personal health data but only aggregated service metrics, in compliance with data privacy rules. To ensure integrity and trustworthiness, the PNLA incorporates strong security measures (such as encrypted data files). This transparency feature means the system can trace who viewed or changed any information, helping to prevent tampering and in compliance with GDPR requirements.
Functionally, the platform serves multiple user groups. Patients and advocacy groups will be able to view summarized, real-time indicators (for example, average wait times by service and region) via the national transparency portal. Meanwhile, health managers and policymakers (regional health directors, hospital directors general and top management, ministry officials, etc.) gain a unified dashboard of performance data, enabling them to identify bottlenecks and allocate resources where they are most needed. Official documents stress that the PNLA’s interoperability standards and data flows were chosen to integrate with regional systems, facilitating uniform data sharing and supporting service improvement.
Criticisms and challenges
Although proponents tout efficiency gains, the PNLA has drawn significant criticism from regional authorities, clinicians and consumer and patient groups. A chief concern is data integrity: critics warn that if performance metrics directly affect resource decisions or sanctions, regions might be tempted to artificially manipulate waiting lists to show better compliance. In fact, audit reports have documented manipulation in the past – for example, the Tuscany Court of Auditors found that local methods (so-called “pre-lists” and frozen lists) had altered the official waiting‐time data. Such experiences fuel fears that under a national monitoring regime, data could again be skewed, undermining trust in the platform’s accuracy.
Another key criticism is the lack of clarity on enforcement. The waiting-list law empowers the central government to intervene if regions fail to comply, but details remain vague. Regional leaders have demanded explicit rules: for instance, they have asked that clear indicators and thresholds be defined to trigger government intervention, in order to guarantee “certainty and transparency” in the process. Without such specifics, governors worry that sanctions could be applied arbitrarily.
More broadly, critics decry an overly performance-driven logic that ties outcomes strictly to sanctions or rewards. Consumer advocates (for example, the association Altroconsumo) argue that merely penalizing underperformance ignores underlying problems. They note that the government has introduced measures such as fines and even takeover of regional health authorities, but without parallel investment in staff or funding, this risks merely shifting problems onto regions that already lack resources. In their view, focusing on annual wait-time targets and punishing gaps can be counterproductive: the literature suggests that sanctions alone rarely yield lasting improvement, and may breed gaming of metrics. Thus, some experts call for a more balanced strategy (for example, combining incentives with genuine capacity-building) rather than a strict scorecard mentality. In sum, stakeholders caution that a narrow emphasis on targets and oversight – without addressing chronic underfunding and staff shortages – could distort priorities and fail to solve the real causes of long waits.