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“Figure 3.4 shows that the majority of health funding in the WHO European Region comes from public sources (on average 71.7% in 2019). Based on this data, in 2019, public funding for health in Italy was above the EU average with 73.9%. The remainder was funded privately, mainly through OOP spending (23.3%), as voluntary health insurance(VHI) only plays a minor role (2.1%).⁶ The growing trend of total private expenditure and its main components over the period 2012–2019 is reported in Table 3.4. Total private expenditure in Italy was approximately EUR 40 billion in 2019 (Del Vecchio et al., 2020). Of this, EUR 35.8 billion were OOP expenditure (including both co-payments and direct payments), while the remaining EUR 4.3 billion were for VHI, occupational medicine (paid by companies) and services offered by non-profit institutions (e.g. Italian Red Cross). The latter consist of non-compulsory financing arrangements and programmes that are based on donations from the general public, the government or corporations. In 2020, only OOP expenditure was significantly reduced (to EUR 33.9 billion), while other components remained almost stable.”

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“Public spending as a proportion of total health expenditure was 74 % in 2019 – lower than the EU average of 80 %. Most of the remaining expenses came from direct out-of-pocket (OOP) payments by households (23 %), as voluntary health insurance (VHI) only plays a minor role (covering only 3 % of the total). The COVID-19 emergency prompted additional funding injections in 2020 to support the health sector (Box 3).”

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.

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“Italy’s National Health Service (NHS) is decentralised and regionally based. The central government channels general tax revenues for publicly financed health care, defines the benefits package and exercises overall stewardship. Each region is responsible for organisation and delivery of health services through local health units and via public and accredited private hospitals. This model was maintained during the COVID-19 pandemic, but leadership and administrative authority for the national response to the crisis were partly centralised (Box 2).”

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.

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“In 2014, public spending accounted for 75.6% of total spending on health, mainly from general tax revenues, while OOP payments and VHI accounted for 21.2 and 0.9%, respectively (WHO, 2016). These shares have been relatively stable in the last 15 years (Armeni & Ferré, 2012).”

Source: Francesca Ferré. “Italy.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

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“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“

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.

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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 in the US and sixteen other nations.

Page last updated October 5, 2023 by Doug McVay, Editor.