Forgotten diabetes in Naples and Salerno: a complaint about spending caps that penalize patients compared to other provinces.

The management of public healthcare in Campania is once again at the center of a heated institutional and social controversy. At the center of the controversy is the branch of diabetes and, in particular, recent regional measures—specifically, Regional Council Resolution No. 540 of October 8, 2026, and Executive Decree No. 316 of September 30, 2026—which establish spending caps and regulate the failure to compensate for underspending among the various local health authorities (ASL) in the region.

This explosive situation was forcefully denounced by Dr. Flavio Petroccione, President of the Campania Diabetics Association and a diabetic himself, who, in a formal letter addressed to the Minister of Health, Professor Orazio Schillaci, the President of the Campania Region, the Hon. Roberto Fico, Vice President Mario Casillo, and the highest regional health authorities, highlighted a structural inequality that severely penalizes citizens of the provinces of Naples and Salerno compared to those of Caserta, Avellino, and Benevento.

Demographic disproportion and the paradox of blocked funds

Campania holds the highest national record for diabetes prevalence, with approximately 500.000 people suffering from this chronic disease and a diagnosis rate of 7,5% of the regional population. Given such significant numbers, the region's economic planning should have adopted distribution criteria strictly proportional to the actual healthcare burden.

Conversely, the contested provisions continue to allocate 50% of total diabetes funding to the Caserta and Avellino local health authorities, leaving the provinces of Naples and Salerno—where the vast majority of Campania's patients are concentrated—with completely insufficient resources.

The result of this rigid and unbalanced distribution is twofold:
The Caserta and Avellino local health authorities experience significant underutilization of allocated funds every year (in the 2025 financial year alone, approximately €850.000 remained unused, concentrated in just two diabetes centers).

In the large metropolitan and provincial areas of Naples and Salerno, budgets are being exhausted increasingly earlier each month, leaving patients without financial coverage.

The human cost: paid visits and forgoing treatment

The Diabetics Association's complaint highlights the absurdity of a system that prohibits compensation for underutilization in diabetology. Unlike what happens in Campania for other lifesaving therapies—such as dialysis and radiotherapy, for which compensation is regularly provided—diabetes is excluded from this virtuous mechanism, despite providing equally essential services and being protected by a specific regional law (Regional Law No. 9/2009).

"Compensating for underutilization does not entail any new spending commitment for the Region: it simply allows funds already allocated and unused in some areas to be allocated to those where demand exceeds the budget," the official document emphasizes.

Failure to activate this mechanism prevents the recovery of approximately €800.000, resources that would have allowed for over 47.000 diabetes check-ups (considering that the Regional Health Service reimburses just €17,90 per visit).

Starting November 1st, once the funds have run out, most diabetics in Naples and Salerno will be forced to pay entirely out of pocket for these visits, which are essential for renewing their treatment plans. Without these plans, patients risk being left without insulin, medications, and blood sugar monitoring devices.

Unequal treatment and its impact on public health

The situation outlined reveals a profound rift in the implementation of the Essential Levels of Care (LEA). The data cited by the Association show that the Campania Region, through previous guidelines (including DGRC no. 642/2009 and DCA no. 88/2013), had established an average annual per capita expenditure per diabetic patient of €240.

Today, that parameter is respected only in the Local Health Authorities of Caserta and Avellino, while for diabetics in Naples and Salerno the actual expenditure drops to less than 100 euros per year, effectively creating a category of "second-class patients".

This economic gap has a direct impact on the health of the population:
Refusal of treatment: Many patients, belonging to low- or very low-income social groups, when faced with the obligation to pay for services, forgo treatment, as repeatedly documented in reports by the GIMBE Foundation.

Life expectancy and mortality: Campania has the lowest life expectancy in Italy (81,7 years in 2024 compared to a national average of 83,4) and very high mortality rates linked to diabetes complications.

Chronic complications and hospital costs: The lack of continuity of care contributes to the onset of devastating diseases such as heart attacks, strokes, chronic kidney failure (resulting in the need for dialysis), retinopathy, and the devastating phenomenon of diabetic foot, which in Campania alone causes approximately 600 amputations each year. Paradoxically, the supposed savings on spending caps translates into an unsustainable increase in hospital costs related to emergencies and avoidable hospitalizations.

The request for immediate intervention

In light of this scenario, the Campania Diabetics Association, supported by the institutional attention of the opposition council (with the involvement of the group leader, the Hon. Gennaro Sangiuliano) and the authoritative monitoring of the GIMBE Foundation, formally requests the Region to intervene without delay through three key points:

Immediately extend the compensation for underutilization to the diabetes branch, similarly to other lifesaving therapies.

Adjust the spending cap for diabetes (still at €12,85 million, equal to just 2% of outpatient specialist care) to the true prevalence of the disease.

Revise the criteria for allocating resources among local health authorities, making them proportional to the diabetic population actually served in the areas.
The ball is now in the Regional Council's court and the relevant ministries, called upon to heal a welfare wound that directly impacts the fundamental rights of Campania's citizens.