## Facts

- Article 6(1)–(2) of Provincial Law of Trento, March 15, 1983, No. 6, shifted responsibility to local health units (USL) for the *health-care* costs of non-self-sufficient elderly people placed in nursing homes.
- The same provision required provincial action to set limits for the coverage of this funding change for nursing homes operating outside the National Health Service (SSN/NHS) framework, including quantitative limits (such as caps tied to the number of persons covered) and related parameters for expenditure.
- In the underlying administrative dispute, the Comune di Trento sought to have the Province/USL charged with the health-care portion of nursing-home expenses for a non-self-sufficient elderly resident and requested reimbursement of sums paid to a municipal nursing home.
- The referring administrative court (TRGA di Trento) had already addressed the allocation of non-health “hotel”/assistance components of nursing-home costs in the main litigation, treating those non-health components as distinct from health services.
- The TRGA suspended the remaining proceedings and referred a question to the Constitutional Court, challenging the constitutional legitimacy of Article 6(1)–(2) insofar as it permitted limits on publicly funded health services for non-self-sufficient elderly persons in nursing homes.
- The referring court questioned whether limiting coverage and related expenditure for nursing-home health services conflicted with Article 32 of the Constitution (right to health) and Article 3 (equality), including concerns that the law drew an unjustified distinction affecting non-self-sufficient persons who required ongoing care.

## Issues

1. Whether Article 6(1)–(2) of Trento Provincial Law No. 6/1983, allowing limits on coverage and expenditure for nursing-home health services for non-self-sufficient elderly persons, violates Article 32 of the Italian Constitution.
2. Whether the same limits violate Article 3 of the Constitution by introducing unreasonable unequal treatment connected to a person’s condition of self-sufficiency or the setting in which care is provided.

## Decision

- The Constitutional Court held the constitutional question **not well founded** and upheld Article 6(1)–(2) of Trento Provincial Law No. 6/1983.
- On Article 32, the Court reaffirmed that the right to health is a fundamental constitutional right, while clarifying that the entitlement to obtain public health services is implemented through legislative and administrative choices regarding organization and financing.
- The Court concluded that limits tied to legislatively defined parameters and public resource constraints are not, by themselves, unconstitutional, so long as the legal framework does not nullify the protected interest in health by denying necessary care as a matter of law.
- On Article 3, the Court found no unconstitutional inequality in a scheme that differentiates between types of costs and responsibilities (health-care services versus non-health components of residential care) and that structures coverage through objective criteria tied to service organization and funding.

## Legal Principles

- The constitutional protection of health includes both: (a) protection of a person’s physical and psychological integrity against unlawful harm (a right directly protected against third parties), and (b) access to public health services, which depends on statutory implementation and service organization.
- As a right to public services, Article 32 permits the legislature (and competent territorial authorities within their powers) to define the modalities, scope, and financing of health services, including through planning tools and spending parameters.
- Financial and organizational limits on publicly provided health services are constitutionally permissible when they reflect reasonable legislative choices and do not, in their design, empty the protection of health of its essential substance.
- Equality under Article 3 does not forbid differentiated allocation of public responsibilities where distinctions rest on rational criteria, including the functional separation between health-care services and non-health residential-assistance components delivered in the same facility.
- In the setting of territorially organized health administration, a province may regulate funding mechanisms for services within the public health framework, provided the measures remain consistent with constitutional guarantees and general principles governing public health provision.

## Conclusion

Judgment No. 455/1990 upheld Trento’s statutory scheme that placed nursing-home health-service costs for non-self-sufficient elderly persons on local health units while permitting limits tied to predetermined parameters and coverage rules. The Court rejected challenges under Articles 32 and 3, holding that access to public health services is constitutionally protected but structured through legislative choices about organization and available resources, and that the differentiation between health-care costs and non-health residential-assistance costs is not arbitrary discrimination.


Italian Healthcare Case, Constitutional Case No. 455/1990 (1990)