[Brief but truthful history of intramoenia freelance activity.]

The practice of freelance work within public structures (Alpi) by employed doctors is a unique feature of the Italian National health service (Nhs). This legislation, introduced by the Amato government through Decree no. 502 of 1992, has undergone multiple regulatory interventions over the years to monitor and balance this activity with the services provided at an institutional level, as well as to address waiting lists. The Alpi was initially introduced as a means to compensate for the low salaries of doctors in the Italian Nhs. It was believed that allowing doctors to work as freelancers would give patients greater choice of professionals and help reduce waiting lists. However, the use of Alpi, particularly in light of the prolonged waiting lists experienced after the pandemic, has become a way to bypass this issue. This creates a clear contradiction and inequalities within a public health service. Nevertheless, as the data presented in the article demonstrates, Alpi is not the cause of the waiting lists. Given the current political, contractual, and financial framework, it may not be possible to completely abolish Alpi. However, various initiatives can be undertaken to regulate it and minimize potential conflicts of interest.