The day after the hearing of the ISS (Institute for Social Security) Executive Committee before Council Commission IV, DOMANI-Motus Liberi returns to the figures presented by the Institute, calling on the Government to introduce checks on the appropriateness of prescriptions, transparent criteria for staffing, and a renovation plan for the existing State Hospital, without waiting for the new one to be built.
Below is the full statement.
The data presented by the ISS Executive Committee before Council Commission IV describe a significant level of healthcare activity: in 2025 roughly 450,000 specialist visits, 1.2 million laboratory tests and 90,000 radiology procedures were carried out, for a population of around 35,000 residents. These figures draw attention to the appropriateness of services and to the need to address the system’s structural weaknesses.
For DOMANI – Motus Liberi, it is essential to introduce clear, shared guidelines for general practitioners, supported by an orientation process and constant monitoring of prescriptions. Data must be collected and analysed, including to compare activity volumes over time and identify any discrepancies worth investigating further. Today there is no systematic check on the clinical appropriateness of prescriptions: a gap that must be closed. This does not mean imposing rigid limits or quotas that risk discouraging doctors from prescribing when it is genuinely necessary. A balance must be struck: rules and checks should support professionals, not replace their clinical judgement.
The management of ISS staff must also be based on clear, transparent criteria linked to the real needs of each department. It is important to verify how resources are distributed and whether staffing assignments match the needs of individual operating units. For D-ML, decisions on hiring, appointments and work organisation must be grounded in competence and service requirements, free from political interference. Healthcare must be able to rely on professional, stable management, in the interest of both patients and those who work every day within the ISS.
It remains urgent to address the overload of the Emergency Room and to strengthen local Health Centres. Care pathways and community-based services need to be better organised, so that citizens can access the care best suited to their needs.
As for the new State Hospital, there is still no defined project, no clear timeline and no clarity on funding: the risk is that it remains a distant goal, while the existing building continues to show serious problems and requires constant intervention. D-ML believes it is now essential to begin a renovation and modernisation of the current hospital, immediately guaranteeing the safety of both patients and staff. The new hospital cannot be used as an excuse to postpone the urgent works the current building needs.
At the same time, a broader vision is needed on how healthcare is financed and its value enhanced. Alongside its public role and the guarantee of free care for residents, the hospital should be able to develop private practice activities and paid services for non-resident patients, under clear rules and without diverting resources from ordinary services. A facility capable of attracting patients from outside San Marino could generate revenue to reinvest in the national healthcare system, helping to sustain both its quality and its long-term viability.
Healthcare cannot be managed by simply chasing emergencies. D-ML calls for a clear strategy, adequate oversight and measurable actions: the safety of the existing hospital must be guaranteed immediately, while the Government must finally clarify what future it intends to build for healthcare in San Marino, on what timeline and with what resources.
Press release, DOMANI – Motus Liberi, Press Office
