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HEALTH

Five essential facts about Italy’s public healthcare system

From overall costs to access for foreigners and essential vocab to navigate the admin, here are the five things you need to know about Italy’s public healthcare.

Patients at Tor Vergata hospital in Rome, Italy
Italy’s public healthcare system has its flaws but is still ranked as one of the best ones in the world. Photo by Tiziana FABI / AFP

Wondering how Italy’s healthcare system works and how it compares to systems in other European Union countries?

Though there are a number of principles and standards of medical care that are shared by all member states, each country has its own unique national healthcare system. 

To give you a general idea of what the Italian healthcare system looks like, here are five essential things that you need to know. 

It’s one of the best in the world

Italy’s public healthcare system (or Servizio Sanitario Nazionale, SSN) is by no means perfect. However, the average level of medical care across the boot is very high, so much so that Italy has been ranked among the countries with the best healthcare systems in the world by the World Health Organisation, Bloomberg and World Population Review.  

Prior to the Covid pandemic, Italy enjoyed the second-highest life expectancy in the EU, sitting at 83.1 years at birth.

Due to increased mortality during the Covid pandemic, that value is now 82.4, though Italy remains among the top five European countries when it comes to life expectancy.

READ ALSO: What can Italy teach the rest of the world about health?

Prior to Covid, Italy also had the second-lowest rate of preventable and treatable mortality in the EU, with mortality rates from conditions such as ischaemic heart disease, lung cancer and alcohol-related diseases all sitting well below the EU average. 

Data relative to the last couple of years has yet to be released.

Italian doctors are usually highly qualified. Suffice to say that as many as four Italian universities figure among the top 130 institutes in the world for medicine-related subjects. Sadly though, the rapidly declining number of doctors working in public hospitals and as general practitioners is raising serious concerns about potential future shortages.

It’s decentralised

Italy’s healthcare system is tax-funded and broadly regulated by the Italian health ministry (Ministero della Sanità). However, unlike other European health systems, it operates on a regional rather than national level, leaving major decisions to the relevant local health authorities (Aziende Sanitarie Locali, ASL).

Though they broadly abide by the national guidelines from the health ministry, each individual ASL acts as a somewhat independent healthcare system, managing its own public clinics and medical services.

This means that service provision (including the costs of individual medical procedures and pharmaceuticals) varies depending on the region one is based in. 

Over the years, many have criticised Italy’s decentralised healthcare system for creating imbalances in the level of healthcare services offered across the country, especially between north and south.

In particular, the EU Commission’s 2019 Health Profile Report for Italy noted that “different fiscal capacities and health system efficiency levels across regions” might undermine “the ability of poorer or lower-performing regions to provide access to high-quality health care services”.

Indeed, concerns of this kind have been validated by multiple reports, including Il Sole 24 Ore’s 2019 Health Index, which showed how provinces located in the south of the country generally fared worse than their northern counterparts in categories such as life expectancy and mortality.

Italian doctors in the ICU of Cremona hospital, Lombardy

The number of Italian doctors working in public hospitals or as primary care physicians is rapidly declining, which raises concerns about potential future shortages. Photo by Miguel MEDINA / AFP

It can be accessed by foreign nationals

Italy’s healthcare system is open to all foreign nationals including, in the case of emergency treatment, undocumented people

All EU nationals holding a valid European Health Insurance Card (EHIC) and British nationals with a UK Global Health Insurance Card (GHIC) have regular access to the Italian healthcare system and enjoy the same benefits as Italian residents. 

They are entitled to free access to public primary care physicians (medici di base) and emergency care, and discounted access to specialist consultations, diagnostic exams and non-urgent procedures.

READ ALSO: Who can register for national healthcare in Italy?

As for non-EU nationals, those holding a valid residence permit (permesso di soggiorno) other than one issued for tourism purposes have the right to register with the Servizio Sanitario Nazionale and receive an Italian health insurance card (tessera sanitaria).

The card grants non-EU nationals the same rights and benefits enjoyed by Italian citizens and its validity expires on the same date as one’s relevant residence permit. For details on how to register with the SSN, please refer to the Ministry of Health’s website.

Finally, non-EU nationals visiting Italy for tourism-related reasons are entitled to emergency care and non-urgent medical assistance, though they must pay for both services.

In Italy, urgent medical assistance is provided to anyone in need, regardless of their nationality or immigration status and without asking for upfront payment.

Fees associated with emergency care procedures are generally paid upon hospital discharge and are usually very reasonable.  

Seriate's Bolognini hospital, Italy

Emergency care and hospital admission are free of charge for all Italian residents and European Health Insurance Card holders. Photo by Miguel MEDINA / AFP

It’s fairly cheap

As previously mentioned, urgent medical assistance and access to primary care physicians are free of charge for anyone holding a valid Italian Health Card, a EHIC or a GHIC. 

Most of the remaining services, including diagnostic procedures, specialist visits in out-patient settings and non-urgent medical interventions, fall under a cost-sharing system, meaning that fees are partly paid for by the SSN

The co-payment fee is generally referred to as ‘ticket’, with the amount patients are required to disburse varying according to the type of service required, patients’ own medical and/or financial status and, of course, regional tariffs – each individual ASL establishes the value of its own co-payment fees but costs must never exceed the threshold set by the SSN. 

READ ALSO: ‘How I ended up in hospital in Italy – without health insurance’

Irrespective of regional differences, fees for standard medical procedures or diagnostic exams are generally very reasonable. The maximum imposable fees for the most common healthcare services and pharmaceuticals are listed in this ministerial decree.

Many categories are completely exempt from payment of the above fees. For instance, esenzioni (exemptions) apply to people with severe forms of disability or chronic conditions and low-income patients (under 8,263 euros per year).

For additional details on exemptions, see the health ministry’s website.

It doesn’t allow patients to choose specialists

People opting to see a specialist (e.g., gynaecologist, dermatologist, cardiologist, etc.) through their local ASL cannot choose the doctor they will be referred to as patients are generally given the earliest publicly available appointment within the relevant medical field. 

Consultations with specialist doctors are usually prescribed by a patient’s own physician (medico di base), though they can also be prescribed by physicians patients aren’t necessarily registered with.

A nurse viewing X-rays in Casalpalocco hospital, Rome

Diagnostic exams and non-urgent procedures are paid for through a cost-sharing system wherein the government contributes to part of the patient’s expense. Photo by Alberto PIZZOLI / AFP

The referral comes in the form of a red prescription (or ricetta rossa in Italian) with letters P, D, B and U indicating the different levels of urgency associated with the consultation – P marks the lowest priority level, whereas D is for consultations that must take place within 72 hours from the time of prescription.

The ricetta rossa allows patients to book their appointments online, in person or over the phone by calling the Regional Central Booking Office (Centro Unico di Prenotazione Regionale, CUP). 

When it comes to booking, foreign nationals with a poor command of Italian may need to seek the assistance of a native speaker as operators are rarely fluent in English and most ASL websites do not provide information in English.

Essential Italian vocab:

  • SSN (Servizio Sanitario Nazionale) – National health system
  • ASL (Azienda Sanitaria Locale) – Regional health unit
  • Medico di base – General practitioner or primary care physician
  • Ricetta – Prescription
  • Visita – Appointment 
  • Specialista – Specialist doctor
  • Farmaco – Drug / Medicine
  • Ospedale – Hospital
  • Pronto soccorso – A&E
  • Ticket – Fee
  • Esenzione – Payment exemption 
  • 118 (or centodiciotto) – Italian emergency number

Member comments

  1. In Piemonte as a non-EU national over 65 years old with a Permesso di Soggiorno, I will be required to pay a premium annually in order to receive a tessera sanitaria. Does anyone know the annual cost? Is it income-based?

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HEALTH

How bad is Italy’s north-south ‘healthcare gap’ really?

Despite recent improvements, stark regional differences in healthcare provision persist in Italy and the problem seems to be here to stay, writes Silvia Marchetti.

How bad is Italy’s north-south ‘healthcare gap’ really?

Italians have a sad saying: ‘health is a right in the north, and a hope in the south’. 

Despite recent improvements, regional differences in healthcare standards continue to plague the country, telling a ‘tale of two Italies’ with the country divided in half, and featuring a trend of southerners travelling north for treatment.

The south-north healthcare gap of the past has of course significantly shortened. Things are very different now from the days when Turin doctor Carlo Levi wrote ‘Cristo si è fermato ad Eboli’ (Christ stopped at Eboli) in 1945, when he talked about the shock of seeing poor children in Matera, the capital of Basilicata, with flies in their eyes and infections. 

Today, Basilicata leads southern regions on healthcare performance. And there are significant differences in standards between southern regions, with Calabria and Molise lagging behind Sicily, Puglia and Campania for treatment and services.

READ ALSO: Five essential facts about Italy’s public healthcare system  

But differences remain, and the pandemic has worsened the outlook according to a recent report by the government’s CNEL agency.

Public healthcare expenditure is at a national average of 1,838 euros per person per year. But the figure is much higher in northern regions than in the south: for example, it’s 2,255 euros in Bolzano versus 1,725 euros in Calabria. 

This translates into lower investments in healthcare in the south, ranging from research in medicines and therapies to top doctors and avant-garde treatments. 

The Policlinico A. Gemelli Hospital in Rome. Italy’s capital is home to several highly-rated hospitals and clinics, but some residents still travel north in search of better or faster treatment. (Photo by Filippo MONTEFORTE / AFP)

Waiting lists in the public healthcare system for checks and surgeries are longer in the south than in the north, where all the best doctors tend to be. I’ve met many southern doctors who, after studying abroad, ditched their native regions for Rome or Milan where most of the top-rated clinics and hospitals are located.

Lombardy, Piedmont and Emilia Romagna have always shone when compared to Sicily and Calabria. And even Rome, despite being the capital, lags behind Milan.

However there have been a few improvements in southern standards lately, and the situation varies depending on the type of treatment.

According to the 2021 public hospitals performance report (PNE), even though the north is showing better results in terms of treatments for cancer and orthopaedics, the poorer southern regions are raising standards in some areas.

For instance, among the top 10 facilities with higher proportions of primary angioplasty guaranteed within 90 minutes, a good index of appropriateness and timeliness, seven are based in the south.

READ ALSO: Who can register for national healthcare in Italy?

Still, the gap has led to a type of ‘health tourism’ within Italy. There are no statistics, but I’ve met many southern people who have had to fly to the north for particular treatments, access to top doctors and cutting-edge surgeries, for example for knee and hip replacements. 

They rented apartments or stayed at hotels for weeks after their surgery to undergo rehab and physiotherapy, at considerable extra expense. 

I’ve met others who had to fly from Salerno and Puglia to Millan and Bologna for hip, shoulder and knee joint reconstruction or replacement, with all the hassle of the journey in poor health and the extra transport and accommodation costs it entails. 

It was striking to find that many Romans are among those who regularly travel to Milan for heart and orthopaedic checks and surgeries. Rome does have a few top-rated clinics, but apparently not as many as Milan.

Meanwhile many doctors from Milan, Padua and Bologna come ‘fishing’ for desperate patients in Rome and Naples who have failed to find a surgeon willing to operate on them due to their complex conditions. 

READ ALSO: The parts of Italy with the best (and worst) quality of life in 2022

This healthcare gap in my view will never completely disappear, despite the incoming European funds through the pandemic recovery plan aimed at shortening it.

It will be further reduced in time, but not in the near future, particularly if all the good doctors continue to flee north for higher salaries, prestige and a more promising career.

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