Five essential facts about Italy’s public healthcare system

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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.

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.  

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.

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