top of page


Updated: Mar 20, 2021


  • Life expectancy in Italy is 83.1 years, second highest in Europe after Spain

  • Healthcare per capita spending is EUR 2,483 which is below the EU average (EUR 2,884)

  • In 2017, 8.8% of GDP spending was on healthcare, 1% below the EU average of 9.8%

The Italian Health Service established in 1978. As per the constitution, the Central government collects the taxes and determines the national statutory benefits package. It is the responsibility of 19 regions and two autonomous regions to deliver healthcare services. A general manager appointed by the governor at the local level is responsible for providing the services.

Healthcare system is decentralized in 3 levels

  • National level: The Ministry of Health makes three-year plans, and healthcare policies are made accordingly

  • Regional level: Regional bodies implement healthcare plans based on the resources. Different co-payments exists because of the disparity in the geometry

  • Local level: Local level is responsible for delivering the healthcare services


Public financing accounted for 75.8% of healthcare spending, accounting for 9.1% of GDP. The public sector is financed through a corporate tax (approximately 35.6% of the total in 2012) and a fixed proportion of national value-added tax revenue (approximately 47.3% of the total in 2012).

The regional bodies can generate their own revenues.

The local bodies can raise additional revenues so that the government can make additional spending.

PRIVATE HEALTHCARE SYSTEM: Private healthcare system plays a minor role in the Italian healthcare system accounting for 1% of total expenditure. Six million people possess additional private health insurance.


The coverage in Italy is universal. All the citizens of Italy and legal foreign residents are covered. Temporary visitors can get healthcare services by paying the cost of therapies.

Service at the point of use is free based on the positive and negative list. Positive list includes pharmaceuticals, inpatient care, preventive medicine, outpatient specialist care, home care, primary care, and hospice care. Negative list includes cosmetic surgery; services covered only on a case-by-case basis (orthodontics and laser eye surgery); and services for which hospital admissions are likely to be inappropriate (cataract surgery).


Patients no need to pay anything for the general practitioner. For specialists, the out-of-pocket payment for specialists is about a maximum of EUR36.15.


For syndicate reports please check here



Primary care:

Primary care will be provided self-employed and independent physicians, general practitioners, and pediatricians. The payment levels, duties, and responsibilities of GPs are based on the consultation between central agencies and GP's trade unions.

Outpatient care:

Local health units or by public and private accredited hospitals provide outpatient care. The patient can opt public or private accredited hospital but not the specialist. Outpatient specialist visits are provided by specialists who have contract with the National Health Service.


Public funds are provided to public and private hospitals. Public hospitals are managed by local health units or as semi-independent public enterprises. Additional funds are provided for teaching hospitals.


In Italy, reimbursement decisions are made at the central level. After getting approval from regulatory bodies, manufacturing company submits for reimbursement in one of the following categories.

Class A: Drugs which are indicated for chronic diseases and life-saving drugs

Class C: Drugs which are not covered by the NHS

Class H: Drugs which are delivered at the hospitals

AIFA determines the prices based on innovation and classifies the new products as follows:

  • Treatment for serious diseases

  • Treatment intended to reduce the seriousness of diseases

  • Treatments for non-serious diseases

  • The extent of added benefit is determined based on clinical benefit and competitors.

AIFA uses the following classification to quantify the clinical benefit considering the primary endpoint and surrogate endpoints:

  • Major

  • Partial

  • Minor

Based on the above scores, the extent of therapeutic innovation was classified as

  • Important

  • Moderate

  • Modest


Once the drug was approved, the manufacturer has to negotiate with the Pricing and Reimbursement Committee.

Criteria that are considered for these negotiations are

  • Cost-effectiveness for pharmaceuticals indicated for therapies for which there was no proper treatment

  • Risk-benefit ration compared to other therapies

  • Costs of other medicines with the same therapeutic efficacy

  • Market share of new pharmaceuticals

  • Prices and consumption in other countries within Europe

  • Economic impact on NHS

Drugs which are classified under Category C are free priced.

The drug price negotiations are considered at the central level. However, the local levels have different co-payment rates based on the revenues of regions.


If the information is useful and would like to support us, please help by clicking donate button on the header and donate. Your contribution makes a big difference to us


For pipeline, market overview, SLRs, and market access reports (syndicate and customised) please write to

For all syndicate reports: Click here



bottom of page