Public vs private: What are your healthcare options in Italy?
A doctor’s visit in Italy can mean a long wait - unless you pay to skip the queue. The Local weighs up the pros and cons of using Italy's public and private healthcare options.
Italy has a reputation for having one of the best healthcare systems in Europe: skilled physicians, advanced technology, and quality facilities available free of charge to every citizen.
But is that actually the case? In reality, across the country, access to quality healthcare varies widely — and since the 1990s, Italy’s world-famous public system has gradually given ground to a growing number of private providers who offer top-notch services at a top-shelf cost.
That means, when you need health services the most, navigating Italy’s system can be a complicated and potentially costly affair.
Your rights to care
The right to public healthcare is enshrined in Italy’s constitution, which recognizes “health as a fundamental right of the individual and the interest of the community.”
Since 1978, when Italy’s national health service (Servizio Sanitario Nazionale, or SSN) was first established, it has provided free, public health services based on the principles of universality, equality, and fairness.
In practice, this all means that all Italian citizens and most legal Italian residents have a right to access some basic public healthcare services free of charge, and other services on a co-pay system.
If you are resident in Italy for reasons of work, family reunification, asylum, or medical care, it is mandatory that you are registered with the public health insurance system. This means applying for your tessera sanitaria or health card after your residency paperwork is complete.
See our guide to who can register for national healthcare, plus more information about applying for (and renewing) your tessera sanitaria here.
If you are resident in Italy for other reasons — for example, to study at a university — you can still opt to enroll, for an annual fee.
Italy also recognizes health insurance provided by any EU country without a tessera sanitaria — you can show your European health card (EHIC). You are required to swap it for an Italian card if you're in the country for more than six months.
Italy has also made international agreements with a handful of countries to recognize their state insurance as well — these include Australia, Argentina, Brazil, Bosnia-Herzegovina, Serbia, Macedonia, Montenegro, Monaco, and Tunisia. Talk to your local Italian embassy if you're from one of these countries to get the documentation you need.
The public system
But, in reality, what does your tessera sanitaria get you?
First and foremost, it covers all emergency care. If you need an ambulance ride or a stop by the pronto soccorso (emergency room), this will be provided free of charge.
You will also be assigned a general practice doctor from a list in your region, who will be your first point of contact for any non-emergency care. Many of these doctors are also specialists in a particular field of health, though not all will be comfortable working in English.
READ ALSO: How to make a doctor's appointment in Italy
In practice, though, these physicians are often massively oversubscribed, counting thousands of patients under their care. Wait times for an appointment can often be lengthy, if you can even get through to their booking line. If you don’t like your doctor, you can only change them once per year, by applying again to your local health authority.
Italy’s healthcare system is said to be among the best in the world, but stark regional imbalances persist. Photo by Miguel MEDINA / AFP
If you require any non-emergency care — blood tests, a specialist exam, or certain prescriptions — you will need to receive a referral from this doctor. This takes the form of a paper ricevuta, a card specifying the services you need featuring codes and barcodes to be scanned when booking and on arrival at your appointment.
You'll usually need to book these appointments yourself, either online or at a pharmacy. You won’t have a choice in what specialist you are referred to, and you will likely face a lengthy wait for these services, which are often performed at the local hospital.
These services are generally not free. Even with a health card, you will be required to make copayments for specialist visits and exams.
READ ALSO:
- How bad is Italy’s north-south ‘healthcare gap’ really?
- Italian healthcare is stuck in the past - but now it has a chance to modernise
- Five essential facts about Italy’s public healthcare system
For example, if your doctor orders full blood work — a procedure that involves more than a dozen different laboratory tests — you may pay as much as €100 in copayments or more, as the public system will only cover up to eight tests at any one time.
You will also need to make nominal copayments on certain prescription drugs.
In theory, these fees are subject to certain maximums and should be geared to your household income. And they will be lower than the fee applied if you decide to take the private option (see below).
Dental care is free for children under 16, but only emergencies are covered for everyone else.
A bigger problem may be a lack of availability of specialist appointments, which can mean a long wait. Sometimes you may be able to get an appointment sooner by travelling to a distant part of your region, or to another region.
Because Italy’s health system is managed by regional authorities, access to care varies greatly across the country. A 2015 report by the OECD found “profound regional differences” indicating many in the south of the country were not receiving timely access to preventative medicine.
Today, while some cities in northern Italy are known for their world-beating medical facilities, they are also often plagued by long wait times, partly because southern residents often have to travel north for care that is not available in other areas.
The private option
These concerns have given rise to an expanding market for private healthcare in Italy, which offers the chance to skip the line — at a cost.
Private providers can offer specialist services without a referral from your general practitioner, and often have much shorter wait times: a week or two, or even a few days, as opposed to several months.
Though they are discouraged from doing so, you may find your general practitioner advising you to seek out private care to avoid a long wait.
See our complete guide to healthcare options during pregnancy in Italy.
It’s worth noting that these private practices do not necessarily offer better facilities than their public competitors. Some operate out of the same hospital facilities as their public counterparts.
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)
Their services can also be very costly. A single appointment can cost anywhere from €60 to €150 or more, and any follow-up exams or prescriptions will not be covered by the public system.
Though most Italians still pay these costs out-of-pocket, there are a number of private health insurance plans that can help spare you the financial headache.
At their most basic, these policies, known as polizze salute, cover emergency care and little else. Policies like these are sometimes a requirement for residency applications, and usually cost just a few hundred euro per year.
If you’re looking to supplement public health care with access to private specialists, however, expect to pay €100 per month or more. For this, you can expect perks like private rooms during hospital stays or cover for home care after discharge.
READ ALSO: ‘How I ended up in hospital in Italy – without health insurance’
To apply, you’ll need to undergo a medical checkup and declare any previous conditions. These policies are usually subject to age limits and some common chronic conditions, like diabetes, may be uninsurable.
Unlike American policies, insurers usually require that you pay up front, and will reimburse you only when you provide the proper paperwork. In some regions, where accredited private hospitals provide private care, your company may have a relationship that allows for direct billing.
Ultimately, if you have the choice, the decision to go with private care comes down to a cost-benefit analysis: how long are you willing to wait — and how much would you pay to skip the queue?
What are your experiences of using Italy's public or private healthcare services? Please leave a comment below or fill out our Italian healthcare survey.
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See Also
Italy has a reputation for having one of the best healthcare systems in Europe: skilled physicians, advanced technology, and quality facilities available free of charge to every citizen.
But is that actually the case? In reality, across the country, access to quality healthcare varies widely — and since the 1990s, Italy’s world-famous public system has gradually given ground to a growing number of private providers who offer top-notch services at a top-shelf cost.
That means, when you need health services the most, navigating Italy’s system can be a complicated and potentially costly affair.
Your rights to care
The right to public healthcare is enshrined in Italy’s constitution, which recognizes “health as a fundamental right of the individual and the interest of the community.”
Since 1978, when Italy’s national health service (Servizio Sanitario Nazionale, or SSN) was first established, it has provided free, public health services based on the principles of universality, equality, and fairness.
In practice, this all means that all Italian citizens and most legal Italian residents have a right to access some basic public healthcare services free of charge, and other services on a co-pay system.
If you are resident in Italy for reasons of work, family reunification, asylum, or medical care, it is mandatory that you are registered with the public health insurance system. This means applying for your tessera sanitaria or health card after your residency paperwork is complete.
See our guide to who can register for national healthcare, plus more information about applying for (and renewing) your tessera sanitaria here.
If you are resident in Italy for other reasons — for example, to study at a university — you can still opt to enroll, for an annual fee.
Italy also recognizes health insurance provided by any EU country without a tessera sanitaria — you can show your European health card (EHIC). You are required to swap it for an Italian card if you're in the country for more than six months.
Italy has also made international agreements with a handful of countries to recognize their state insurance as well — these include Australia, Argentina, Brazil, Bosnia-Herzegovina, Serbia, Macedonia, Montenegro, Monaco, and Tunisia. Talk to your local Italian embassy if you're from one of these countries to get the documentation you need.
The public system
But, in reality, what does your tessera sanitaria get you?
First and foremost, it covers all emergency care. If you need an ambulance ride or a stop by the pronto soccorso (emergency room), this will be provided free of charge.
You will also be assigned a general practice doctor from a list in your region, who will be your first point of contact for any non-emergency care. Many of these doctors are also specialists in a particular field of health, though not all will be comfortable working in English.
READ ALSO: How to make a doctor's appointment in Italy
In practice, though, these physicians are often massively oversubscribed, counting thousands of patients under their care. Wait times for an appointment can often be lengthy, if you can even get through to their booking line. If you don’t like your doctor, you can only change them once per year, by applying again to your local health authority.
If you require any non-emergency care — blood tests, a specialist exam, or certain prescriptions — you will need to receive a referral from this doctor. This takes the form of a paper ricevuta, a card specifying the services you need featuring codes and barcodes to be scanned when booking and on arrival at your appointment.
You'll usually need to book these appointments yourself, either online or at a pharmacy. You won’t have a choice in what specialist you are referred to, and you will likely face a lengthy wait for these services, which are often performed at the local hospital.
These services are generally not free. Even with a health card, you will be required to make copayments for specialist visits and exams.
READ ALSO:
- How bad is Italy’s north-south ‘healthcare gap’ really?
- Italian healthcare is stuck in the past - but now it has a chance to modernise
- Five essential facts about Italy’s public healthcare system
For example, if your doctor orders full blood work — a procedure that involves more than a dozen different laboratory tests — you may pay as much as €100 in copayments or more, as the public system will only cover up to eight tests at any one time.
You will also need to make nominal copayments on certain prescription drugs.
In theory, these fees are subject to certain maximums and should be geared to your household income. And they will be lower than the fee applied if you decide to take the private option (see below).
Dental care is free for children under 16, but only emergencies are covered for everyone else.
A bigger problem may be a lack of availability of specialist appointments, which can mean a long wait. Sometimes you may be able to get an appointment sooner by travelling to a distant part of your region, or to another region.
Because Italy’s health system is managed by regional authorities, access to care varies greatly across the country. A 2015 report by the OECD found “profound regional differences” indicating many in the south of the country were not receiving timely access to preventative medicine.
Today, while some cities in northern Italy are known for their world-beating medical facilities, they are also often plagued by long wait times, partly because southern residents often have to travel north for care that is not available in other areas.
The private option
These concerns have given rise to an expanding market for private healthcare in Italy, which offers the chance to skip the line — at a cost.
Private providers can offer specialist services without a referral from your general practitioner, and often have much shorter wait times: a week or two, or even a few days, as opposed to several months.
Though they are discouraged from doing so, you may find your general practitioner advising you to seek out private care to avoid a long wait.
See our complete guide to healthcare options during pregnancy in Italy.
It’s worth noting that these private practices do not necessarily offer better facilities than their public competitors. Some operate out of the same hospital facilities as their public counterparts.
Their services can also be very costly. A single appointment can cost anywhere from €60 to €150 or more, and any follow-up exams or prescriptions will not be covered by the public system.
Though most Italians still pay these costs out-of-pocket, there are a number of private health insurance plans that can help spare you the financial headache.
At their most basic, these policies, known as polizze salute, cover emergency care and little else. Policies like these are sometimes a requirement for residency applications, and usually cost just a few hundred euro per year.
If you’re looking to supplement public health care with access to private specialists, however, expect to pay €100 per month or more. For this, you can expect perks like private rooms during hospital stays or cover for home care after discharge.
READ ALSO: ‘How I ended up in hospital in Italy – without health insurance’
To apply, you’ll need to undergo a medical checkup and declare any previous conditions. These policies are usually subject to age limits and some common chronic conditions, like diabetes, may be uninsurable.
Unlike American policies, insurers usually require that you pay up front, and will reimburse you only when you provide the proper paperwork. In some regions, where accredited private hospitals provide private care, your company may have a relationship that allows for direct billing.
Ultimately, if you have the choice, the decision to go with private care comes down to a cost-benefit analysis: how long are you willing to wait — and how much would you pay to skip the queue?
What are your experiences of using Italy's public or private healthcare services? Please leave a comment below or fill out our Italian healthcare survey.
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