A significant shift in Italian primary healthcare is currently under consideration as the Ministry of Health proposes extending pediatric care for adolescents until they reach adulthood. Under a new draft decree aimed at reforming general medicine, the Italian government is proposing that children remain under the care of a pediatrician of free choice until the age of 18.
This proposal, part of a broader overhaul of territorial medicine spearheaded by Health Minister Orazio Schillaci, seeks to bridge the often-turbulent transition from pediatric to adult care. Currently, the standard age for transitioning from a pediatrician to a general practitioner (GP) is 14, though this can be extended to 16 in specific cases. By raising this threshold to 18, the reform aims to provide continuity of care during the critical developmental stages of late adolescence.
The measure is not an isolated change but a key component of the Riforma Schillaci
, a strategic effort to reorganize primary care and ensure that “Case della Comunità” (Community Houses) turn into fully operational hubs for local health services. The draft has already been presented to regional authorities, signaling the government’s intent to standardize the delivery of primary care across Italy’s diverse regional health systems.
The Shift to 18: Why the Change Matters
The transition from a pediatrician to a family doctor is often a point of vulnerability for young patients. In the current system, the jump at age 14—or 16 for some—forces teenagers to navigate a new medical relationship just as they enter the most complex years of puberty and psychological growth. By extending the pediatrician’s role until the age of 18, the ministry intends to maintain a stable, trusted relationship between the patient and a specialist trained specifically in adolescent health.
According to reports from ANSA, this proposal is contained within a detailed initial draft of the reform decree. The move recognizes that the biological and psychological needs of a 14-year-old are vastly different from those of a legal adult, and that pediatricians are better equipped to handle the nuances of adolescent medicine than general practitioners who manage a broad spectrum of adult pathologies.
For families, this change would eliminate the administrative burden and potential disruption of switching doctors during high school years. It also allows for a more gradual hand-off to adult medicine, ensuring that chronic conditions or mental health challenges are managed by a specialist who has known the patient’s history since childhood.
Integrating the ‘Case della Comunità’
The extension of pediatric care is inextricably linked to the operationalization of the Case della Comunità. These centers are designed to be the first point of contact for citizens, reducing the pressure on hospital emergency rooms and providing a multidisciplinary approach to health. The Schillaci reform aims to redefine the “convenzione” (the agreement between the state and independent doctors) to introduce new organizational obligations.
The goal is to move away from the isolated “studio medico” (private medical office) and toward a more integrated model. As detailed by Quotidiano Sanità, the reform introduces a voluntary dependency model, where doctors can choose to operate within these community hubs, thereby enhancing the coordination between pediatricians, GPs, and other specialists.
This structural change is intended to solve several systemic issues:
- Reduced Fragmentation: By housing various specialists under one roof, the “patient journey” becomes more streamlined.
- Better Data Sharing: Integrated centers allow for more efficient electronic health record management.
- Preventative Focus: With pediatricians staying with patients longer, there is a greater opportunity for preventative screenings and adolescent wellness checks.
Challenges and Professional Pushback
Despite the potential benefits for patients, the reform has not been met with universal acclaim among medical professionals. Some sectors of the general medicine community have expressed concerns over the “organizational obligations” and the shift in how they are compensated and managed. Critics have described some aspects of the reform as useless and harmful
, particularly regarding the impact on retirement ages and the rigidity of new scheduling requirements.
The primary tension lies in the balance between professional autonomy and the state’s desire for a centralized, standardized health service. Even as the extension of pediatric care to 18 is generally viewed as a positive for public health, the administrative framework used to implement it—specifically the new requirements for doctors to work within the Community Houses—remains a point of contention.
Comparison of Pediatric Care Access
| Feature | Current System | Proposed Reform (Bozza) |
|---|---|---|
| Standard Transition Age | 14 years | 18 years |
| Special Case Extension | Up to 16 years | N/A (Standardized to 18) |
| Care Setting | Primarily private offices | Integrated Case della Comunità |
| Doctor’s Role | Pediatrician of free choice | Pediatrician of free choice |
What Happens Next?
The proposal currently exists as a draft decree that has been presented to the Regions. Because healthcare in Italy is managed regionally, the success of the reform depends on the coordination between the central government in Rome and the regional health authorities. The next phase will involve refining the text based on regional feedback and the ongoing negotiations with medical unions.
Once the decree is finalized and signed, the transition to the 18-year limit will likely be phased in, allowing current 14-to-17-year-olds to decide whether they wish to remain with their pediatrician or transition to a GP. Official guidelines on how to exercise this choice and the specific timelines for the rollout of the Community Houses are expected in the coming months.
As this reform progresses, the Italian healthcare system is attempting to modernize its primary care to meet the needs of a changing population. Whether the “Riforma Schillaci” can successfully integrate these changes without alienating the medical workforce will be the defining challenge of the coming year.
We invite our readers to share their thoughts on this proposal. Do you believe extending pediatric care to 18 years will improve adolescent health outcomes? Let us realize in the comments below.