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Healthcare for expats in Italy

The standard of healthcare in Italy is very high and the system is ranked 2nd best in the world (after France) by the World Health Organization. Italy also has the 11th highest life expectancy in the world, thanks in part to a healthy Mediterranean diet, but also to outstanding healthcare facilities, diagnosis and treatment.

Spending on public health accounts for over 9% of GDP in Italy, which is above average compared with other developed countries. Such priority funding in public healthcare has created an accessible patient-led system and world-class medical professionals.

How does the healthcare system works

Healthcare in Italy is provided through a mixed public-private structure. The public system makes up the majority of health provision and is free or very low cost to all Italian and EU residents, regardless of income (non-EU citizens must have full residency status in Italy). However, most Italian residents, including EU and Non-EU expats, also have a supplementary private health insurance policy that allows them quicker access to specialist treatment and private hospitals (see below).

Servizio Sanitario Nazionale (National Health Service):

Established in 1978, Italy’s public health system is managed by the Ministry of Health and funded by a combination of income tax and Government supplements. The contribution to healthcare paid by employees starts at around 10% of income for the first €20,600 p.a. and drops to around 4.6% on any income above this figure. It is not possible to opt out of paying health taxation on income, even if you have a private insurance policy. The remaining funding comes from federal and regional taxes and the healthcare system is managed at local level.

The SSN provides free access to general practitioners, low-cost or free prescription medicines, hospital treatment, specialist care, lab services and emergency services. Eye tests are also offered free to those with residency status. The only exception is dental treatment, which is mostly carried out privately.

Decentralised management of the SSN and notorious Italian bureaucracy have led to marked differences in the quality of care and funding received from region to region. As with other public services in Italy, healthcare in the wealthy Northern regions of Italy is of a much higher standard than those in the poorer South.

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Structure of the SSN

General Practitioners/Family Doctors (Medici di Famiglia) are entirely funded by the SSN and refer patients for specialist hospital treatment and diagnosis. Many GPs do not speak English or other foreign languages so knowledge of Italian will help when explaining a medical problem.

Hospitals (ospedali) in Italy are mostly public facilities, with a small number of private hospitals and clinics. Medical staff also carry out privately-funded treatment from within public hospitals, but most treatments can be accessed free through the SSN. Standards of hospital care are very high but waiting times can be longer for those without private insurance.

Specialist hospital treatment and diagnostic tests are free to those on low incomes or cost up to €35 on a ‘co-pay’ patient contribution. Costs for treatment in private hospitals and clinics can be covered by a health insurance policy.

Prescription Medicine (ricetta or ‘ticket’) costs vary by region but do not cost more than €5 or are free to low income families. Italian pharmacies stock many over-the-counter medicines that are only available with a prescription in other countries, so it is worth consulting a pharmacist if you have regular medicine.

Pharmacy opening times can be sporadic and most close over the long lunch hour so be sure to check before going to get your medicine. Also, over-the-counter medicines such as headache tablets, can only be bought in pharmacies and are not sold in shops or supermarkets.

How to access healthcare in Italy

Expats from EU member countries can access the public healthcare system (SSN) from the moment they enter Italy using a European Health Insurance Card (EHIC) and are entitled to the same treatment as Italian citizens, regardless of employment and residency status. The card is available free of charge to all EU citizens.

EU citizens wishing to stay in Italy longer than three months must register their presence with the local health authority (Azienda Sanità Locale) where they will be assigned a GP.

Expats from outside the EU must also register with the SSN and are only eligible to free treatment if they have full residency (permesso di soggiorno) or citizenship in Italy. Those who have not applied for or finalised their residency status must have a private insurance policy to cover healthcare costs. Evidence of private insurance is mandatory for non-EU expats when applying for a permesso di soggiorno (permission to stay) or Italian citizenship.

Private healthcare in Italy

Although public healthcare is free and of a very high quality, many Italians choose to take out a private health insurance policy (assicurazione sulla salute) as a way of accessing treatment quicker.

Private hospitals in Italy are among the finest in the world, with short waiting times, impressive facilities and world-renowned doctors. Treatments vary in cost but are regulated by the Ministry of Health.

Most foreigners, especially non-EU citizens, also opt to take out private health insurance along with access to public healthcare. Some policies are funded by employers but most are paid for by the patient.

Policies vary greatly in what they cover but a basic scheme will cost a minimum of €1500 per year. Most policies offered by Italian insurance companies are designed as supplementary schemes for Italians and aren’t generally suitable for foreigners. Most expats choose a company in their home country (such as BUPA International) to cover their health needs abroad.

Emergency Medicine

Ambulance services (pronto soccorso ambulanza) are run by the Local Health Authority and various charities, including the Italian Red Cross. Emergency response and treatment is free to all, regardless of nationality or residency status. However, non-EU citizens who have not finalised their residence permit to stay in Italy must have insurance to cover further treatment while in hospital.

If you need an ambulance, call the emergency number 118 and you will be asked what service you require. If you can make it to hospital yourself, head to the casualty/emergency department (pronto soccorso).

Should you need urgent medical treatment and are unable to get to hospital you can also call the local duty doctor service (guardia medica) which is available from 8am to 8pm. Numbers can be found in the local telephone directory for where you live.