Outpatient "Specialist Practitioners" in Italy in the years before and after the COVID-19 pandemic. The case of the Piedmont Region.

This study highlights a progressive decline in the public provision of Outpatient Contracted Specialist medical care in Piedmont during the years 2017-2023, despite the increase of waiting lists lengths, out-of pocket private expenditure and renounce to health services. The phenomenon has been enhanced, but not induced, by the COVID-19 pandemic and had its origins mainly in the lack of medical applications, in the shifting of part of financial resource towards psychologic care, but also in an objective decline in the demand of medical job positions from regional Local Health Authorities. The observed reduction is likely to hinder access to public outpatient specialist medical care, mostly in community settings, and to undermine basically the implementation of Proximity Health Networks as outlined in Ministerial Decree n. 77 of 2022.