… would consist in the teleological definition of value areas, in the enunciation of purposes that cross horizontally the order, involving disparate interests or incorporating objects dispersed in the formal order of competences.
Reserved for the exclusive competence of the state legislator would be endowed with a strong expansion capacity, such as to invest also matters of regional competence, both concurrent and residual.
Also by virtue of this expansionary trend, the essential levels clause has been attributed a unifying function within the polycentric institutional system, capable of understanding the plurality of subjective legal situations that constitute the bundle of rights of the modern concept of social citizenship.
It is therefore understandable why the ordinary legislator, 66 in dialogue with the national planning tools,
67 has qualified as essential those necessary levels (i.e. the types of assistance, services and health services they present, for specific clinical conditions or risk , scientific evidence of a significant benefit in terms of health, at an individual and collective level, in relation to the resources used) and appropriate
(with respect to both the specific health needs of the citizen and the methods of providing services), which therefore define, in health care, the maximum ceiling, the maximum level – not the threshold, that is the minimum level – of the guarantees offered to all associates.
It therefore seems that, through the constitutional provision, we wanted to clarify how the objective set with the definition of the essential levels is not so much that of identifying the minimum levels of assistance or, even, of identifying only the services that must be provided, 68 rather it is to ensure a common citizenship of rights throughout the territory, regardless of the place of residence.
In other words, the constitutional provision seems to adapt to the needs of an institutional structure that tends to be federal, in which, in the face of ‘levels’ of physiological differentiation
, uniform standards relating to the satisfaction of needs deemed particularly worthy of protection are guaranteed regardless of belonging. administrative territorial, as an expression of a need for equality between citizens to whom our legal system cannot remain indifferent.69
From this need emerges a final profile that connotes the constitutional provision of the essential levels, that is the binding value of the same, to the extent that they do not constitute a mere programmatic orientation,
but pose precise constraints70 that circumscribe the scope of action of the institutional subjects in charge. to the supply of services for which rights arise that can be immediately activated, even regardless of the organizational structure set up by the administrations.71