Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Italy’s COVID-19 Policy
Health System Financing
Health System Personnel
Health System Physical Resources and Utilization
Long-Term Care
Health Information and Communications Technologies
Medical Training
Pharmaceuticals
Political System
Economic System
Population Demographics
People With Disabilities
Aging
Social Determinants & Health Equity
Health System History
Health System Challenges
Annual household out-of-pocket payment, current USD per capita (2019): $677
Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed June 10, 2022.
Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 3.4%
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 23.31%
Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.
Out-Of-Pocket Expenditure Per Capita In US$ (2019): $677.4
Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.
“As noted in section 3.1, in 2019, the public share of funding for health care was 73.9%, with the remaining 26.1% of health spending coming from private sources.8 Of the share of private expenditure, OOP [Out Of Pocket] expenditure (i.e. cost sharing and direct payments) accounted for 23.3%, with the rest coming from VHI [Voluntary Health Insurance] (2.1%), payments made by companies (e.g. occupational medicine, 0.5%), and services offered by non-profit entities (e.g. health care for undocumented migrants, 0.2%).
“Until 2019, private expenditure had grown over time, both in absolute terms (from EUR 34.4 billion in 2012 to EUR 40 billion in 2019) and in relation to total health expenditure (from 21.5% in 2010 to 26.1% in 2019). In particular, OOP expenditure steadily increased from EUR 31.5 billion in 2012 to EUR 35.8 billion in 2019, reaching a peak of 36.1 billion in 2018. This growing trend was interrupted in 2020, when OOP expenditure by households dropped to EUR 33.9 billion (Del Vecchio et al., 2021).
“Tax deductions may be an incentive for people to use services that incur OOP payments, since 19% of medical expenses exceeding the ceiling of EUR 129.11 incurred in the previous year can be deducted from personal income tax (IRPEF). In 2019, 46% of taxpayers benefited from tax deductions related to health care costs (Del Vecchio et al., 2020). However, it is also worth noting that in Italy OOP expenditure is mainly borne by households directly rather than through other forms of expenditure brokered by third-party payers – for example, VHI purchased by individuals or companies for their employees (see section 3.5).”
Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.
“In Italy, co-payments are made up of two broad categories: 1) co-payments for goods (i.e. medicines) and 2) co-payments for services (e.g. outpatient specialist services, some laboratory and diagnostic tests, and non-urgent access to emergency care). The cost sharing for medicines is further divided into: 1) a fixed amount user charge (known as the “ticket”) per package, which is set by regions, and 2) the difference between the market price and the reimbursement price for off-patent medicines (i.e. internal reference pricing). There are several exemption categories (e.g. by age or income level) but no overall annual cap on co-payment spending or other major financial protection mechanisms. Primary and inpatient care are totally free at the point of use for everyone (Table 3.3).
“In 2019, the level of co-payment spending was estimated at EUR 2.9 billion and has been stable both in absolute terms and as a percentage of household consumption expenditure between 2009 and 2019, despite the introduction of an additional user fee of EUR 10 (with regional variations) charged on specialist outpatient services between 2011 and September 2020 (known as the “super ticket”). The only relevant growth concerned the revenues deriving from internal reference pricing differences, which increased from EUR 0.4 billion in 2009 to EUR 1.1 billion to 2017 (Del Vecchio et al., 2020). This data suggests that policies aiming to incentivize the prescription and use of generics were not so effective in deterring the consumption of branded drugs, with a consequent increase in the financial burden on households. In 2020, the level of co-payment spending dropped to EUR 2.3 billion. This was particularly evident for outpatient services (from EUR 1.3 billion in 2019 to EUR 0.8 billion in 2020), and in line with the overall trend of the other private expenditure components (Del Vecchio et al., 2021) (Fig.3.7).”
Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.
“Historically, OOP spending has made up a little more than one-fifth of all health spending. However, over the last decade, the share has gradually increased, reflecting rising cost-sharing requirements for many health services and pharmaceuticals in several regions (see Section 5.2). Co-payments are required for diagnostic procedures, pharmaceuticals, specialist visits in outpatient settings and unjustified (non-urgent) interventions in hospital emergency departments. Each region establishes its own co-payment levels for pharmaceuticals, with various exemptions for some population groups, meaning that co-payment levels are not homogeneous across the country. There are no annual ceilings on co-payments, so these have the greatest impact for heavy users of health services who are not eligible for exemptions.”
Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“Although the basic benefit package covers a wide range of services, direct out-of-pocket (OOP) payments by households are relatively high (24 %), making up most of the remaining expenses. Private health insurance plays a minor role, covering only about 2 % of total health expenditure.”
Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“Out-of-pocket (OOP) expenditure as a share of health spending in Italy increased from 20.5 % in 2010 to 23.2 % in 2019. This is well above the EU average of 15.4 % (Figure 14). Voluntary health insurance plays a minor role in Italy, representing just 2.8 % of total health spending.
“A large proportion of OOP payments in Italy are spent on outpatient medical care, making up 45 % of the total, and on outpatient pharmaceuticals, which constitute 30 % of total OOP spending. While GP consultations are free, co-payments are levied on specialist visits with a GP referral (without a referral, the full cost is paid by patients) and diagnostic procedures. For pharmaceuticals, there may be regional co-payments and direct OOP costs resulting from the difference between the price of the purchased product and that of a cheaper alternative. Catastrophic household expenditure due to OOP spending is relatively high in Italy (8 % of households in 2016), and is mostly concentrated in the lowest income quintile (OECD/EU, 2020).2
“All COVID-19-related treatment, testing prescribed by a doctor if the individual was in direct contact with another individual who tested positive for COVID-19 and vaccinations are available to all residents free of charge.”
Source: OECD/European Observatory on Health Systems and Policies (2021), Italy: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.
Page last updated Feb. 1, 2023 by Doug McVay, Editor.
