A guide to the Italian Health care system and how it works

In 1978, when the Italian National Health Service (Servizio Sanitatio Nazionale) was formed, the Italian health care system was ranked one the of the best in the world. 

Health care in Italy is based on communal, rather than individual, ideas of success and care. With an aim of universal coverage, human dignity and solidarity all applicable services are either free or offered at a lower cost compared to market prices.

The Italian National Health Service is regionally organised and controlled by all levels of government: national, regional and local.

The Italian Constitution

As stated in the Italian Constitution (Art. 32), the national government is responsible for granting that all residents, in every region of Italy, have access to this benefit package for all essential levels of care.

How it gets funded

The majority of Italy’s public health system is financed through the collection of a corporate tax called IRAP

This funding is pooled from a regional level and then collected on a national one . The corporate tax return isn’t equally cut for all regions. Instead, it is given back in proportion to a specific region’s contribution scheme. 

To balance this out, the government also collects a proportional peronal income tax called IRPEF.  In this case, unlike the corporate tax return, the national government redistributes the financing to regions that lack the sufficient resources to provide all essential levels of care. 

How it's organised

Once the Italian national government distributes the tax revenue to local governments, it is the local government's job to organize and deliver these health care services through local health care units (ASL, formerly USL).  This means that local governments have the freedom to determine the macro structure of their health care systems. 

These local units are managed by one person, who is appointed into leadership by the local government. Within these units, Italian citizens have access to primary care, hospital care, outpatient care, public health care and health care that relates to social care.

What is covered 

There are two lists which determine what is covered and what is not covered by the Italian National Health Service. Both lists are defined by specific criteria. Each health care service is ranked by medical necessity, effectiveness, human dignity, appropriateness and efficiency in delivery. 

If a health care service meets these criteria, it is put on the positive list. Some services on this list are pharmaceuticals, preventive medicine, inpatient care, outpatient specialist care, home care, primary care and hospice care. The services listed on the positive list are covered for all citizens.

What is not covered

Services that are not covered for patients fall under a different set of criteria. Services that are covered only on a case-by case basis and services for which hospital admission is deemed inappropriate are not offered or covered by the Italian National Health Service.

Some of these services that are not offered are cosmetic surgery; orthodontics or laser eye surgery, which are considered case-by-case; and cataract surgery, which is considered an inappropriate hospital admission.

Dental care is often another service that is not covered. However, there are a few exceptions to this rule, like children up to 16 years old, vulnerable populations and people in economic or emergency need. 

Successes of Italy's Health Care System

Ph: Yulia Grigoryeva / Shutterstock

As a result of these successful health care policies and a variety of other welfare measures, Italy has seen a dramatic increase in the standard of living for all citizens, as well as an increase in the quality of life. There has also been a boom in the life expectancy of Italian citizens. According to the World Health Organisation men are now reaching an average life expectancy of 80.5 years, and women are expected to live an average of 84.9 years.

Services for non- Italian patients

Italian citizens are not the only people who have access to the Italian National Health Service. This health care system is also available to legal foreign residents, who gain this universal coverage automatically. In 1998, the Italian National Health Service also provided undocumented immigrants access to the health care system. However, this access is limited to urgent and essential services. 

Anyone that does not fall under these categories, like temporary visitors, will have to pay for all health services. Typically, people that fall under this category will be required to pay for the entire cost of a treatment, unless they are covered on a separate international health care plan. International SOS is one platform that offers insurance coverage for United States citizens traveling abroad. Some private insurance companies also offer international healthcare coverage.