From bureaucracy to waiting times, up to the limits of the Nomenclator: what emerges from the double survey on prosthetic assistance in Italy
There is a paradox that silently runs through one of the most delicate pillars of the healthcare system: while aids and prostheses concretely improve the quality of life, the path to obtaining them continues to be an obstacle in itself. Not a detail, but a structural problem that involves patients, caregivers and professionals, and which today clearly emerges from a double investigation conducted by the Confindustria Dispositivi Medici Study Center together with AITO and other entities in the sector.
An obstacle course for patients
The numbers are difficult to ignore: over eight out of ten patients (84.8%) encounter difficulties in obtaining aids and prostheses through the National Health Service, while 63% are forced to incur personal expenses. These are not exceptions, but a widespread normality, which is built between excessively long waiting times (56.5%), complex bureaucratic procedures (51.1%) and a feeling of disorientation that affects almost two thirds of users, who are poorly informed about the solutions available.
Yet, at the heart of this critical issue, a figure emerges that tells much more than it seems: 84.8% of patients declare themselves satisfied with the help received. Despite everything, when the system works, it really works. The problem is getting there.
Limited customization and devices to fix
The journey doesn’t stop at delivery. In 54.4% of cases, the aid must be modified after being received, a clear sign of a lack of initial customization. A limitation that becomes even more evident if we consider that 70.6% of patients have experienced at least once the absence of coverage for necessary accessories or adaptations.
We thus enter a gray area where the right to care is intertwined with individual economic capacity, transforming essential support into an additional expense.
The professionals’ point of view: a system that does not follow reality
If patients describe the difficulty of the journey, healthcare professionals describe the structural causes. 77.5% believe that the current nomenclature envisaged by the LEA Prime Ministerial Decree 2017 only partially allows for real customization of the aids, while 93% report inconsistencies between the technical descriptions and the devices actually available.
The result is a system that struggles to keep up with technological evolution: inadequate tariffs, missing or obsolete devices, technical ambiguities. It is not just an administrative issue, but a misalignment between regulation and innovation.
The crux of the competitions and the quality of the aids
One of the most critical points concerns the tender procedures for “almost tailor-made” aids. 78.7% of professionals report operational or clinical problems, with a direct impact on quality and choice. Almost 70% believe that these competitions have had a negative effect on the quality of the aids provided.
In this scenario, the use of economic integration by patients becomes not only frequent, but structural: for 70.1% of professionals it represents an obstacle to the appropriateness of the provision.
Possible reforms: between urgency and vision
The indications that emerge are clear and convergent. Overcoming tenders for complex aids, ensuring national uniformity in the paths and introducing a mandatory multidisciplinary evaluation for the most complex cases are among the priorities reported. Not only that: 77.9% of professionals are in favor of a new list dedicated to aids for complex disabilities.
It is the signal of a system that asks to be rethought not in detail, but in its approach.
A system to be updated, not patched
The point is not simply to improve efficiency, but to recognize the role of assistive devices as tools of social inclusion, as well as care. When a system forces long waits, complex procedures and personal expenses, it is not just slowing down a healthcare process: it is implicitly redefining who can truly access a more independent life.
And this is where the issue stops being technical and becomes political, social, cultural. Because prosthetic assistance is not a marginal segment of the healthcare system: it is one of its most sensitive indicators. And today it tells, with a precision that is difficult to ignore, the distance between what exists and what is really needed.
