Italy’s Ministry of Health has unveiled a draft decree aimed at revitalizing the nation’s primary care system by strengthening the role of family doctors within newly established Community Health Centers. The proposal, presented by Health Minister Orazio Schillaci, seeks to address longstanding challenges in access to local healthcare services while introducing structural changes to how general practitioners operate within the public system.
The draft legislation, informally referred to as the “Schillaci Decree,” introduces a dual-track model for family physicians, allowing them to either remain under the existing national convention system or transition voluntarily into salaried positions with the National Health Service. This shift is designed to ensure consistent staffing and operational capacity at Community Health Centers, which are positioned as central hubs for delivering preventive care, chronic disease management, and proximity-based health services across urban and rural areas.
According to official presentations shared with regional authorities, the reform emphasizes that participation in the salaried track would be entirely voluntary, preserving the current contractual framework for those who prefer to maintain their independent status. Although, physicians choosing the convention-based path would be expected to fulfill recent obligations, including mandatory service hours within Community Health Centers and a shift from fee-for-service remuneration to outcome-based compensation tied to preventive care metrics and chronic patient management.
The initiative forms part of a broader national strategy to modernize Italy’s territorial healthcare infrastructure, particularly in response to growing demand from aging populations and the rising prevalence of multi-morbidity. By integrating family doctors more directly into community-based care networks, the government aims to reduce avoidable hospital admissions, improve coordination between social and medical services, and enhance early detection of health issues among vulnerable populations.
Regional health officials have been consulted during the drafting phase, with some expressing cautious support while calling for clearer guidelines on funding mechanisms and workforce planning. The decree is expected to undergo further review before potential adoption, with officials indicating it could be finalized by mid-2026 if consensus is reached among stakeholders.
Understanding the Dual-Track Model for Family Physicians
The core innovation of the Schillaci Decree lies in its dual approach to organizing primary care labor. Under the first option, family doctors can continue operating under the existing national agreement (convenzione) with local health authorities (ASLs), but with modified compensation rules. Instead of being paid primarily based on the number of registered patients, their income would increasingly reflect performance indicators such as participation in preventive screenings, management of diabetic or hypertensive patients, and completion of required shifts at Community Health Centers.
This performance-linked remuneration model aligns with broader European trends toward value-based care, where financial incentives are tied to health outcomes rather than volume of services rendered. Similar systems have been piloted in regions like Lombardy and Emilia-Romagna, though national implementation would represent a significant shift in how primary care is financed across Italy.
The second option allows physicians to voluntarily transition into salaried roles within the National Health Service, effectively becoming public-sector employees akin to hospital-based doctors. This path offers greater job stability and predictable working hours but requires adherence to centralized staffing assignments, potentially including placements in underserved areas where recruitment has historically been challenging.
Minister Schillaci emphasized that the voluntary nature of this transition is critical to gaining professional buy-in, noting that many family doctors have expressed concerns about losing autonomy under top-down mandates. By framing the shift as optional, the government aims to encourage gradual adoption while preserving the flexibility that has long characterized Italy’s primary care model.
Role of Community Health Centers in the Reform
Community Health Centers (Case di Comunità) serve as the operational foundation of the proposed reform. These facilities are designed to bring together general practitioners, nurses, social workers, and specialists under one roof to provide integrated, accessible care—particularly for elderly patients, those with chronic conditions, and individuals facing socioeconomic barriers to health services.
Each center is expected to function as a first point of contact for non-emergency health needs, offering services ranging from routine check-ups and vaccinations to wound care, mental health support, and coordination of home-based care. By decentralizing certain functions from hospitals, the centers aim to alleviate pressure on emergency departments and improve continuity of care for patients navigating complex health journeys.
The decree specifies that family doctors opting into the salaried track would be assigned to these centers based on regional workforce needs, with schedules potentially including evening or weekend shifts to improve access for working populations. For those remaining under the convention system, fulfilling a minimum number of hours at a Community Health Center would grow a condition for receiving full compensation under the new performance-based framework.
Pilot programs in regions such as Tuscany and Campania have demonstrated that co-locating primary care providers with social services can lead to better patient engagement and reduced duplication of services. The national rollout envisions scaling these lessons while adapting to local demographic and infrastructural realities.
Implications for Chronic Disease Management and Preventive Care
A significant focus of the reform is on improving the management of chronic illnesses, which account for a substantial portion of healthcare utilization and costs in Italy. Conditions such as diabetes, cardiovascular disease, and chronic obstructive pulmonary disease require ongoing monitoring, medication adjustment, and patient education—areas where consistent primary care relationships are known to improve outcomes.
Under the proposed system, family doctors would receive additional incentives for meeting benchmarks in chronic disease control, such as maintaining target blood pressure or HbA1c levels among their patient panels. This approach reflects evidence showing that proactive, longitudinal care reduces complications and hospitalizations more effectively than episodic interventions.
Preventive services, including cancer screenings, immunizations, and lifestyle counseling, would likewise be weighted more heavily in the performance metrics used to determine compensation. By aligning financial rewards with preventive engagement, the reform aims to shift the focus of primary care from treating illness to promoting long-term wellness—a transition already underway in several European national health systems.
Public health experts note that success will depend on adequate investment in digital infrastructure, such as shared electronic health records and remote monitoring tools, to support coordinated care across providers. The decree does not currently specify funding for such upgrades, leaving this aspect to be addressed in subsequent implementation phases.
Stakeholder Perspectives and Implementation Challenges
The proposal has elicited varied responses from medical associations, regional governments, and patient advocacy groups. The Italian Federation of General Practitioners (FIMG) has acknowledged the demand for reform but urged caution regarding potential administrative burdens and the risk of undermining the doctor-patient relationship through excessive performance tracking.
Regional health authorities, while generally supportive of strengthening territorial care, have highlighted disparities in readiness across territories. Some southern regions, which face chronic shortages of medical personnel and limited investment in health infrastructure, may require additional support to meet the staffing and operational demands of the new model.
Patient representatives have welcomed the emphasis on accessibility and proximity but stressed that the success of Community Health Centers will depend on their ability to attract and retain qualified staff, particularly in rural and inner-city areas where healthcare workforce gaps are most pronounced.
Implementation timelines remain uncertain, with the decree still in the consultation phase. Officials have indicated that feedback from professional orders and regional governments will be incorporated before a final version is submitted for legislative review. If approved, the changes would likely be introduced in stages, beginning with pilot regions before expanding nationally.
What This Means for Patients and Practitioners
For patients, the reform promises more predictable access to primary care services, especially through expanded hours and integrated support at Community Health Centers. Those managing long-term conditions may benefit from closer monitoring and better coordination between their family doctor, specialists, and social services.
For physicians, the choice between maintaining convention-based practice or transitioning to salaried employment introduces a new dimension of career planning within Italy’s healthcare system. While the voluntary nature of the shift is intended to reduce resistance, concerns persist about potential future pressures to conform to one model over the other as the reform evolves.
the success of the Schillaci Decree will depend on balancing flexibility with accountability, ensuring that incentives promote quality care without creating unintended consequences such as over-surveillance or geographic maldistribution of resources. Ongoing evaluation will be essential to assess whether the dual-track approach achieves its goals of strengthening local healthcare delivery while preserving the core values of accessibility and continuity that define Italy’s National Health Service.
As the proposal moves through the consultation process, stakeholders await further details on funding allocations, timelines for rollout, and mechanisms for monitoring impact. Updates are expected from the Ministry of Health in the coming months, with regional discussions continuing to shape the final form of the decree.
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