Sommario: 

1. Premessa. 

2. Il quadro giuridico di riferimento. 

2.1. Il quadro giuridico europeo: la qualificazione del trasporto sanitario come attività economica o no. 

2.2. La qualificazione come appalti degli accordi stipulati dagli enti pubblici con le organizzazioni di volontariato che erogano i servizi di trasporto sanitario. 

2.3. Il quadro giuridico nazionale. 

3. Limiti e modalità delle procedure selettive di affidamento. 

4. Le vicende regionali italiane più recenti e rilevanti. 

4.1. La legge sul trasporto sanitario della Regione Marche. 

4.2. La legge toscana sul trasporto di emergenza. 

5. Conclusioni.

Abstract: 

The essay deals with healthcare transport services provided by nonprofit organizations, often awarded in many EU member States without a call for tenders and without the publication of prior notice in the EU Official Journal. This practice has sparked many disputes on the role played by nonprofit organizations in a market economy and has also raised the question on whether public procurement rules should be applied to healthcare services. Consequently the European Court of Justice has been increasingly called to decide on cases concerning the award of transport healthcare services to nonprofit organizations. Moreover, recently the Commission has launched infringement procedures against Italy, referring to contracts awarded by Italian regional administrations, and this has created profound instability in relations between nonprofit organizations and local authorities and affected deeply their welfare systems, based more on solidarity than on competition. The essay examines the above mentioned decisions of the ECJ, as well as some recent Italian regions laws. It attempts to ascertain how the peculiarities of the Italian welfare model may be preserved, without infringing upon European law.