OVERVIEW OF ITALY’S NATIONAL HEALTHCARE SYSTEM

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: %; Total: 100%

Note: “Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”)”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

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.

“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.

“ƒ 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.

“ƒ 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.

“ƒ 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.

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

“ƒ 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.”

“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.”

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.

“In 2019, Italy spent 8.7% of GDP on health care, compared to the EU average of 9.9 %. In the same year, per capita spending reached EUR 2,525 (adjusted for differences in purchasing power), which is over 25 % below the EU average (EUR 3,523) (Figure 7). Historically, health expenditure in Italy has always been lower than the EU average, but slow increases have occurred over the last five years, mainly driven by a growth in private spending. 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.

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.