Lymphedema in many countries is still considered an "aesthetic" problem, even though a chronic, degenerative, and debilitating disease. After a long period of study with internal and external experts, the Italian Ministry of Health has implemented National Care guidelines for lymphedema and other related disorders. This Document represents a fundamental element with regards to diagnostic and therapeutic regulation procedures that satisfy the health needs of these patients. In this paper the description of the main constituents of the document that has revolutionized the possibility of access the best specialized care facilities situated in the country.
S. Michelini (1), M. Cestari (2), M. Ricci (3), A. Leone (4), A. Galluccio (1), M. Cardone (1)
(1) San Giovanni Battista Hospital, Rome, Italy
(2) Vascular Public Consulting Room, Terni, Italy
(3) Rehabilitative Department Torrette Hospital, Ancona, Italy
(4) Carmide Hospital, Catania, Italy
The problem of classifying treatment of primary and secondary lymphedema in both the public and private sectors, derives from a series of considerations. First of all the fact that the same global guidelines of the principal scientific societies that are experts in the subject (i.d. Consensus Document of the International Society of Lymphology) 1,2,3 illustrate the opinions of the leading world experts of the field: some consider lymphedema as an alteration of the lymph transport linked to intrinsic or extrinsic dysfunction of the lymphatic system itself; others consider it a disease. In fact the World Health Organization in the International Classification of Diseases (version number 9-ICD9) recognizes the various forms of lymphedema as diseases and not as symptoms or clinical manifestations. They were also assigned specific codification for the disease: 457.0 Breast cancer related lymphedema and 457.1 for all the other forms of primary and secondary lymphedema.
For these reasons in many countries patients with lymphedema find enormous difficulties coping with their health problems. The confusion and inadequate information, even among clinicians, with regards to the disease discredits even the scientific societies and associations of patients that struggle to be valid advocators for a serious confrontation with politicians who have to decide on funding treatment. As a result of this situation in almost all of the countries in the world a lymphedema patient is obliged to bear high health care costs that only a minority of patients can sustain.
Considering this particular critical situation, in Italy in 2006 a Commission was appointed by the Ministry of Health to draft ministerial guidelines on the management of national public health care for patients affected from lymphedema and other related diseases (Lipedema). The workshop was concluded in 2016 with the publication of a document that stipulates a series of specific health care regulations that guarantee free treatment under the Universal Public National Health Care system for these patients.