Industrial relations in the italian healthcare system: flexibility, management powers and pandemic challenges

Abstract

This study analyzes the problematic aspects of the National Health Service: The progressive reduction of public health spending and the increasing role of public health spending by citizens; the reduction of permanent staff and the increasing use of fixed-term contracts or consultancies; the reduction in the number of hospitals and local care facilities; the slowdown in investment. In Italy, the reorganization of the health service and the counterupdate of public employment have a common matrix, which refer to the Italian Enabling Act of 23 October 1992 No. 421. The SSN is divided into Regional Health Services (SSR) and is required to ensure Essential Levels of Care (LEA). The strengthening of home care services through telemedicine is a key objective for the National Health Service, aimed at patients over 65 years of age and/or with chronic diseases. The links between the organization of health services and labor regulations are carefully studied, with the issue of flexible contracts, which are the “first” way of accessing the health labor market, in particular through fixed-term employment contracts and “somministrazione” contracts. Finally, the stabilization processes put in place by the legislator and the risks of exclusion of certain categories of temporary workers are studied. Legislation should define more precise principles and criteria, in order to ensure “optimal management of staff organization” through rational forms of flexibility, while ensuring the consolidation of established professionalism.