In Milan, both public and private healthcare institutions affiliated with the Lombardy health system experienced a marked decline in healthcare revenues during the first quarter of 2025. The public sector reported a decrease of 5.8%, totaling €132.7 million, while the private contracted sector saw a more substantial decline of 7.5%, amounting to €125.8 million.

According to the Agency for Health Protection (ATS) in Milan, these figures should be reconsidered as they result from changes in the fee structure, specifically the ‘nomenclatore,’ which dictates how outpatient activities are billed and compensated.

ATS officials indicated that some healthcare providers have yet to adapt to the new tariff system, thus rendering the overall assessment of performance 'suspended.'

However, this view is not universally accepted by all hospital directors and experts within the Lombardy region.

Several hospitals have reported significant decreases compared to the same quarter in 2024, suggesting that the issues cannot solely be attributed to shifts in tariff parameters.

Notably, some hospitals managed to achieve positive results despite the general downward trend.

For instance, Niguarda Hospital reported an increase of 1.3%; ASST Pini recorded a 9.6% growth; ASST di Lodi saw a slight rise of 0.6%; and the IRCCS Policlinico di Milano achieved a significant jump of 7%.

These facilities highlighted several factors contributing to their success, including effective service organization, which is closely linked to the availability of medical personnel.

This is particularly evident at Policlinico, which benefits from a pool of university students who often continue their careers at the institution as researchers and subsequently as medical staff.

Incentives for medical personnel, including financial rewards for taking on extra shifts, have also played a role in these hospitals' improved performance.

The Lombardy region had previously allocated new resources last year to address patient waiting lists, with funds advanced for this purpose this year.

However, national funding remains uncertain as the related decree has not yet been issued.

The worst-performing hospitals in the first quarter included ASST Santi Paolo e Carlo, which experienced a decline of 13.5%; ASST Ovest Milanese at 11%; ASST Nord Milano with a 21.9% decrease; Istituto dei Tumori di Milano at 14.7%; and IRCCS Besta, which reported a substantial drop of 23.1%.

Some of these declining trends were already evident last year when the tariff parameters were unchanged, such as the 3.2% decline for ASST Santi Paolo e Carlo and a 14% decrease for IRCCS Besta.