Regional Demand for Doctors and Co.: The Constitutional Court Restricts State Power

With ruling no. 114 of 2025, the Constitutional Court declared Article 5 of Legislative Decree no. 73 of 2024 (Urgent measures to reduce waiting times for healthcare services) unconstitutional insofar as it: a) grants the Ministers of Health and Economy and Finance the power to approve three-year plans for regional healthcare personnel requirements (second sentence of paragraph 2); b) subjects the compensatory measures that the Regions must adopt to increase spending on healthcare personnel to a review of their appropriateness by the Minister of Health and the Minister of Economy and Finance (second sentence of paragraph 2).

This is in light of Article 117, paragraphs 3 and 4, of the Constitution, which assigns to the regions "concurrent legislative power over health protection and residual power over organizational matters," as well as Article 6, paragraph 4, of Legislative Decree No. 165 of March 30, 2001, which assigns the adoption of the three-year personnel needs plan (PTFP) to the "top-level bodies of the administrations," and, finally, the decree of the Department of Civil Service of May 8, 2018 (Guidelines for the preparation of personnel needs plans by public administrations), according to which "the PTFP is adopted by the body responsible for exercising political direction functions and approved in accordance with the respective regulations."

The Constitutional Court, however, declared the first sentence of paragraph 2 of Article 5 of the aforementioned Constitutional Court to be compliant with the Constitution, insofar as it delegates to one or more decrees of the Minister of Health, in agreement with the Ministry of Economy and Finance, following consultation at the State-Regions Conference, the adoption of a "methodology for defining the personnel needs of the National Health Service (SSN) entities" for the purpose of determining the related expenditure, within the scope of the level of funding for the national healthcare requirement.

This provision, the Constitutional Court argues, is in itself neither capable of deepening nor bridging the existing socioeconomic gaps between Italian regions, nor of violating the right to health, nor of infringing on the legislative competence granted to the regions by Article 117 of the Constitution. Moreover, the implementation of this methodology had been advocated by the National Agency for Regional Health Services (Agenas): "... A model aimed at defining, in terms of effectiveness, the need for healthcare personnel at the national level has not yet been identified, while there is little and fragmentary statistical evidence regarding personnel needs at the local level... Furthermore, with regard to personnel dedicated to local services, there is almost no literature on defining needs..."