Italy: Health System Overview - World Health Systems Facts

Life expectancy at birth (years), 2021: 82.2 years
Maternal mortality ratio (per 100,000 live births), 2023: 6
Under-five mortality rate (per 1000 live births), 2023: 2.8
Neonatal mortality rate (per 1000 live births), 2023: 1.6
New HIV infections (per 1000 uninfected population), 2023: ≤0.1
Tuberculosis incidence (per 100,000 population), 2023: 4.4
Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between age 30 and exact age 70 (%), 2021: 9.1%
Suicide mortality rate (per 100,000 population), 2021: 7.0
Adolescent birth rate (per 1000 women aged 15-19 years), 2015-2024: 2.8
Adolescent birth rate (per 1000 women aged 10-14 years), 2015-2024: 0.0
Universal Health Coverage: Service coverage index, 2021: ≥80
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%), 2023: 95%
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the locally recommended age (%), 2023: 85%
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year olds (%), 2023: 92%
Human papillomavirus (HPV) immunization coverage estimates among 15 year-old girls (%), 2023: 46%
Density of medical doctors (per 10,000 population), 2015-2023: 41.91
Density of nursing and midwifery personnel (per 10,000 population), 2016-2023: 67.55
Density of dentists (per 10,000 population), 2016-2023: 8.82
Density of pharmacists (per 10,000 population), 2015-2023: 13.42
Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) (%), 2022: 11.85%
Prevalence of anaemia in women aged 15-49 years (%), 2023: 16.4%

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.

Health expenditure per capita, USD PPP, 2022
– Government/compulsory: $3,255
– Voluntary/Out-of-pocket: $1,036
– Total: $4,291
Health expenditure as a share of GDP, 2022
– Government/compulsory: 6.8%
– Voluntary/out-of-pocket: 2.2%
Health expenditure by type of financing, 2021
– Government schemes: 75.302%
– Compulsory health insurance: 0.159%
– Voluntary health insurance: 2.002%
– Out-of-pocket: 21.894%
– Other: 0.642%
Out-of-pocket spending on health as share of final household consumption, 2021: 3.6%
Price levels in the healthcare sector, 2021 (OECD average = 100): 88
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%
Population aged 15 years and over rating their own health as bad or very bad, 2021: 8.1%
Population aged 15 years and over rating their own health as good or very good, by income quintile, 2021
– Highest quintile: 79.1%
– Lowest quintile: 72.0%
– Total: 73.5%
Life expectancy at birth, 2021: 82.7 years
Infant mortality, deaths per 1,000 live births, 2021: 2.4
Maternal mortality rate, deaths per 100,000 live births, 2020: 4.6
Congestive heart failure hospital admission in adults, age-sex standardized rate per 100,000 population, 2021: 160
Asthma and chronic obstructive pulmonary disease hospital admissions in adults, age-sex standardized rate per 100,000 population, 2021: 23
Hospital workforce per 1,000 population, 2021
– Physicians: 2.33
– Nurses and midwives: 4.62
– Other health service providers: 1.28
– Other staff: 2.78
Practicing doctors per 1,000 population, 2021: 4.1
Share of different categories of doctors, 2021
– General practitioners: 16.6%
– Specialists: 80.0%
– Other doctors: 3.4%
Share of foreign-trained doctors, 2021: 0.9%
Medical graduates per 100,000 population, 2021: 18.2
Practicing nurses per 1,000 population, 2021: 6.2
Share of foreign-trained nurses, 2021: 5.2%
Nursing graduates per 100,000 population, 2021: 17.2
Ratio of nurses to doctors, 2021: 1.5
Practicing pharmacists per 100,000 population, 2013: 128
Community pharmacies per 100,000 population, 2021: 33
Remuneration of doctors, ratio to average wage, 2021
– Specialists
— Salaried: 2.6
Remuneration of hospital nurses, ratio to average wage, 2021: 1.0
Remuneration of hospital nurses, USD PPP, 2021: $40,000
Hospital beds per 1,000 population, 2021: 3.1
Average length of stay in hospital, 2021: 8.5
Average number of in-person doctor consultations per person, 2021: 5.3
CT scanners per million population, 2021: 39
CT exams per 1,000 population, 2021: 102
MRI units per million population, 2021: 33
MRI exams per 1,000 population, 2021: 77
PET scanners per million population, 2021: 4
PET exams per 1,000 population, 2021: 5
Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Total: $692
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 63%
– Voluntary health insurance schemes: 0%
– Out-of-pocket spending: 37%
– Other: 0%
Share of the population aged 65 and over, 2021: 23.6%
Share of the population aged 65 and over, 2050: 34.9%
Share of the population aged 80 and over, 2021: 7.6%
Share of the population aged 80 and over, 2050: 14.2%
Adults aged 65 and over rating their own health as good or very good, 2021: 43%
Adults aged 65 and over rating their own health as poor or very poor, by income, 2021
– Lowest quintile: 24%
– Highest quintile: 14%
– Total: 20%
Limitations in daily activities in adults aged 65 and over, 2021
– Severe Limitations: 16%
– Some Limitations: 32%
Estimated prevalence of dementia per 1,000 population, 2021: 23.4
Estimated prevalence of dementia per 1,000 population, 2040: 29.2
Total long-term care spending as a share of GDP, 2021: 0.9%
Share of informal carers among the population aged 50 and over, 2019
– Daily carers: 8%
– Weekly carers: 3%
Share of long-term care workers who work part time or on fixed contracts, 2021
– Part-time: 29.6%
– Fixed-term contract: 18.5%
Average hourly wages of personal care workers, as a share of economy-wide average wage, 2018
– Residential (facility-based) care: 62
– Home-based care: 59
Long-term care beds in institutions and hospitals per 1,000 population aged 65 years and over, 2021
– Institutions: 21.3
– Hospitals: 0.5

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

Population, Midyear 2022: 59,037,474
Population Density (Number of Persons per Square Kilometer): 199.47
Life Expectancy at Birth, 2022: 84.06
Infant Mortality Rate, 2022 (per 1,000 live births): 2.14
Under-Five Mortality Rate, 2022 (per 1,000 live births): 2.56
Projected Population, Midyear 2030: 57,544,258
Percentage of Total Population Aged 65 and Older, Midyear 2022: 24.05%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 28.35%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 37.14%

Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.

Population, 2021: 59,240,000
Annual Population Growth Rate, 2020-2030: -0.3%
Life Expectancy at Birth, 2021: 83
Share of Urban Population, 2021: 71%
Annual Growth Rate of Urban Population, 2020-2030: 0.1%
Neonatal Mortality Rate, 2021: 1
Infant Mortality Rate, 2021: 2
Under-5 Mortality Rate, 2021: 3
Maternal Mortality Ratio, 2020: 5
Gross Domestic Product Per Capita (Current USD) (2010-2019): $33,226
Share of Household Income (2010-2019):
Bottom 40%: 18%; Top 20%: 42%; Bottom 20%: 6%
Gini Coefficient (2010-2019): 33
Palma Index of Income Inequality (2010-2019): 1.3

Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”
Gini coefficient – Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.
Palma index of income inequality – Palma index is defined as the ratio of the richest 10% of the population’s share of gross national income divided by the poorest 40%’s share.

Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.

Current health expenditure (CHE) per capita in US$, 2022: $3,134.68

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure (OOP) per capita in US$, 2022: $712.75

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%), 2022: 22.74%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%), 2022: 25.56%

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) per capita in US$, 2022: $801.21

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%), 2022: 74.44%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%), 2022: 6.72%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) per capita in US$, 2022: $2,333.47

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Annual household out-of-pocket payment in current USD per capita, 2021: $729

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.

Total Health Spending, USD PPP Per Capita (2021): $4,043

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2023), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 24 May 2023).

“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 2021, Italy’s health expenditure accounted for 9.4 % of GDP, a lower proportion than the EU average of 11 %. When measured per capita, Italy’s spending on health stood at EUR 2 792 in 2021 – an amount nearly one third lower than the EU average (Figure 9). Between 2019 and 2021, government health spending surged by 8.3 % in real terms, while private health expenditure experienced a decline of over 1 %, reflecting disruptions in non-COVID-19 elective care provided by private providers and shifts in patient healthcare-seeking behaviour during the first two years of the pandemic. As a result, the proportion of health expenditure financed through private sources – of which 90 % consisted of out-of-pocket (OOP) spending by households – fell from 26.3 % in 2019 to 24.5 % in 2021. This proportion was nevertheless higher than the EU average of 18.9 %.

“Preliminary expenditure data for 2022 shows a notable year-on-year decline, with health spending per capita returning to a level approximately 2.6 % above its 2019 level. This decline results from a significant reduction in OOP expenditure (-6 %) and a more moderate decline in government health expenditure (-3.5 %), with the latter likely reflecting lower COVID-19-related expenses compared to 2021.”

“In 2022, Italy’s life expectancy at birth was the third highest in the EU at 83.0 years, exceeding the EU average by 2.3 years (Figure 1). Throughout the decade preceding the COVID-19 pandemic, Italy’s life expectancy increased at a rate comparable to the EU average, despite already holding the second-highest life expectancy in the EU in 2010. However, in 2020 Italy experienced a large, above-average drop in life expectancy of 1.3 years, resulting from the large number of COVID-19 deaths in the first year of the pandemic. Over the subsequent two years, Italy’s life expectancy rebounded by 0.7 years, surpassing the EU average increase of 0.3 years. Despite this above-average rebound, in 2022 the life expectancy of the Italian population was still over 6 months below its pre-pandemic level.

“As in other European countries, men in Italy tend to have shorter lifespans than women. In 2022, the average life expectancy of women was85 years – over four years longer than that of men (80.9 years). This gender gap in life expectancy was nevertheless narrower than the EU average, which stood at nearly five and a half years.”

“ The Italian National Health Service, the Servizio Sanitario Nazionale (SSN), was founded in 1978. Over the last few decades, it has undergone a process of decentralization which is now one of the main characteristics of its structure.

“ The SSN provides universal coverage, guaranteed to all. Thecentral government is in charge of establishing the national benefitspackage (known as the Livelli Essenziali di Assistenza, LEA), equalizing allocations to regional health systems and stewardship. Regions are responsible for financing, planning and providing services at the local level, through local health authorities.

“ Hospital and specialist ambulatory services can be provided by the local health authorities through directly-managed hospitals,semi-independent public hospitals (“hospital trusts”) or accredited private providers.

“ General practitioners (GPs) and paediatricians, who are independent contractors, act as gatekeepers to higher levels of care.

“ At the national level, the main planning instruments include 3-year health plans, pacts between regions/autonomous provinces and the central government, and national programmes addressing specific health issues (i.e. the National Chronic Conditions Plan). Guaranteeing the national benefits package and funding allocations also serves to shape planning. At the regional level, planning is based on specific regional health plans, financing and allocation of funds among the local health authorities and adapting national goals to local socio-epidemiological contexts.”

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.

“Until 1992, only the central government could raise taxes and allocate funds to the regions, while the regions funded the local health authorities and their hospitals. Funding was based on past spending; local health authorities lacked cost-containment incentives and overspent their budgets, and the central government habitually covered their deficits. Subsequently, a series of reforms was introduced, underpinned by principles of managerialism, regionalization and managed competition (Fattore, 1999). Managerialism gave local health authorities greater independence but required improvements in performance and encouraged governance techniques resembling those of private companies (Cantù, Ferrè & Sicilia, 2010). Hospitals were allowed to become independent from local health authorities by becoming “hospital enterprises” (hospital trusts), with their own managing board. Reimbursements to providers were based on activity-related funding: diagnosis-related groups (DRGs) for hospitals, capitation for GPs and paediatricians, and fee-for-service for private outpatient specialists (see Chapter 3). More recently, new value-based mechanisms are being introduced for innovative therapies (i.e. for CAR-T therapy, in 2019).”

“Coverage by the National Health Service (known as the Servizio Sanitario Nazionale (SSN)) is compulsory for all residents and opting out is not allowed. Patients are free to choose between public and private providers for many health care services, since it is possible for the public sector to outsource the delivery of health services to accredited private providers. Accredited private hospital beds account for 28% of the total number of beds, but there are great differences in the geographical distribution of private beds among Italy’s 20 regions, with Lombardy and Lazio having a larger share of private beds (Ministry of Health, 2009). The minimum benefits package of services and goods guaranteed by the SSN involves user charges, especially for medicines and outpatient visits.”

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.

“The role of VHI is mainly supplementary, covering faster access and enhancing consumer choice of provider. This is particularly the case for people wishing to use the services of specialists who engage in part-time private practice (inpatient and outpatient) within public hospitals (intramoenia services) (Cavazza & De Pietro, 2011). VHI also plays a complementary role covering: (1) SSN user charges, for example, for medicines, laboratory and diagnostic tests, specialist visits, hospital prostheses and rehabilitation; and (2) services excluded from the SSN, such as dental care, home care for older people (but not residential LTC), cosmetic treatment, thermal care and alternative medicine. VHI has generally been slow to develop, perhaps due to the lack of strong fiscal incentives to encourage VHI take-up among individuals and companies (see further on) and high insurance premiums, which makes VHI unaffordable, especially in the poorer southern areas of the country.”

Italy: Health System Overview - outcomes, coverage, access, needs, costs, expenditures, financing, healthcare workers, hospital beds, technology, pharmaceuticals, reforms - National Policies - World Health Systems Facts

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