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World Health Systems Facts

Italy: Coverage and Access


Universal Health Coverage: Service coverage index, 2021: ≥80

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.


Population reporting unmet needs for medical care, by income level, 2021
– Lowest quintile: 3.5%
– Highest quintile: 0.9%
– Total: 1.8%
Main reason for reporting unmet needs for medical care, 2021
– Waiting list: 0.7%
– Too expensive: 1.1%
– Too far to travel: 0.0%
Population reporting unmet needs for dental care, by income level, 2021
– Lowest quintile: 4.5%
– Highest quintile: 0.6%
– Total: 2.2%
Population coverage for a core set of services, 2021
– Total public coverage: 100%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.


“Italy’s National Health Service (NHS) operates on a regional basis and provides universal coverage to citizens and registered foreign residents. Undocumented migrants are entitled to access urgent and essential medical services. The central government allocates general tax revenues for publicly financed healthcare to regions, defines and supervises regional compliance with the delivery of the guaranteed benefits package (known as ‘essential levels of care’) and exercises overall stewardship. Regions are responsible for the organisation, planning and delivery of health services. A wide range of preventive, primary and community healthcare services is provided through local health authorities, with general practitioners (GPs) acting as gatekeepers to specialist and hospital care. Hospital and specialist ambulatory care are provided by a mix of public and accredited private providers, with significant variation across regions.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Italy: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.


“In 2022, 1.8 % of the Italian population reported experiencing unmet needs for medical care due to either excessive costs, travel distance or waiting times. This proportion was slightly lower than the EU average of 2.2 %, and equal to Italy’s pre-pandemic rate from 2019. A greater proportion of women reported unmet medical care needs, with cost being the primary reason for both genders. Among individuals in the lowest income quintile, 3.3 % reported unmet medical care needs compared to only 0.7 % among those in the highest income group (Figure 17). While this gap was slightly wider than the EU average, it had decreased by over 50 % compared to 2019, driven by a reduction in individuals in the lowest income quintile reporting unmet needs due to cost.

“Similarly, only 1.6 % of Italians reported experiencing unmet needs for dental care – a proportion that was less than half the EU average and lower than the 2.7 % reported in 2019. As with medical care, the main determinant of unmet dental care needs was their cost, reflecting Italy’s limited public coverage for dental care services. The NHS provides these services free of charge exclusively to children under the age of 14 and selected vulnerable groups.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Italy: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.


“As noted in Section 4, the Italian NHS operates on a regional basis and provides automatic, universal coverage for all residents. The healthcare system is structured into three levels – national, regional and local. The national level is responsible for setting the overall objectives and core principles of the national healthcare system. Regional governments, through their health departments, are tasked with ensuring the provision of the ample, standard guaranteed benefits package (known as Essential Levels of Assistance). This package is defined at the national level, and is implemented through a network of population-based health management organisations (known as Local Health Units), public and accredited private hospitals.

“Since 2020, a revised compliance monitoring framework – the New Guarantee System (NGS)– has been implemented at the national level to ensure health services provided by regions align with the Essential Levels of Assistance and adhere to standards of effectiveness, appropriateness and uniformity of service delivery across the country. The NGS uses a selection of performance indicators organised into three macro-areas – prevention and public health, outpatient and hospital care to identify regions that fail to guarantee appropriate access to the Essential Levels of Assistance for their populations (Ministry of Health, 2023b). In 2021, the NGS identified seven regions with insufficient scores in at least one macro-area – a decrease from 10 regions in 2020, but still higher than the six identified in 2019 before the onset of the COVID-19 pandemic (Figure 18). Insufficient scores were mostly concentrated in the southern regions of the country.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Italy: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.


“The SSN covers all citizens and ordinarily resident foreign nationals. Population coverage is automatic and universal. Undocumented migrants are entitled to access only urgent and essential services. Health care for prisoners, which was previously delivered through the Ministry of Justice, was integrated into the SSN in 1999; moreover, prisoners are usually excluded from having to pay co-payments.

“In terms of the scope of coverage, the SSN guarantees the provision of health services included in the national benefits package (LEA) across the entire country. These are delivered through the activities of public providers (i.e. regional and local health care authorities, independent public hospitals (known as “hospital trusts”), university hospital trusts, the tertiary care and research centres (IRCCSs) and private-accredited providers (see Chapter 2). Regions can choose to offer non-LEA services but must finance these themselves. Health care services provided within the SSN (i.e. the LEA) are identified by positive and negative lists using criteria related to medical necessity, effectiveness, human dignity, appropriateness and efficiency in delivery (Lo Scalzo et al., 2009).”

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.


“Positive lists exist for community care services (primary care, emergency care, pharmaceuticals, specialist outpatient care, integrated care, prosthesis care, ambulatory and home care, residential and semi-residential care, and thermal therapy), public health and occupational health services (Torbica & Fattore, 2005). For the latter, there is a list of general community and individual levels of preventive services that are covered, including hygiene and public health, immunization and early diagnosis tools. Hospital services are not specifically defined. Dental care – specifically orthodontics and dental prostheses – is generally not covered and is paid for out of pocket or reimbursed through policies offered by private for-profit and not-for-profit insurance companies (see Box 3.1 and section 3.4).

“Negative lists include ineffective services; services that are covered only on a case-by-case basis, such as orthodontics and laser eye surgery; and inpatient services for which ordinary hospital admissions are likely to be potentially inappropriate (e.g. cataract surgery and carpal tunnel release). For the latter category, regions should provide substitute treatment at other levels of the health care delivery system, such as day hospital and ambulatory care.

“In 2017, the national benefits package was thoroughly revised and updated; in particular new vaccines, services for outpatient care, diagnostic services, neonatal care and health devices were added. It also included a list of rare disease to be covered by the SSN [Italy’s national health service]. Of note, Italy is probably the only country in Europe to introduce a voucher system to subsidize food for patients with coeliac disease.”

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.


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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated July 16, 2025 by Doug McVay, Editor.

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