Healthcare policy
A universal system under pressure, and in reform.
Italy's National Health Service gives every resident access to care financed mainly through general taxation. This page looks at how the system is organised and funded, and at what has changed since 2022.
Architecture
How the SSN is organised.
The Servizio Sanitario Nazionale was established by Law 833 of 23 December 1978, replacing a fragmented system of health insurance funds with a universal, tax-financed service. It rests on Article 32 of the Constitution, which protects health "as a fundamental right of the individual and as a collective interest".
The system has three tiers. The State sets the framework, defines the essential levels of care and decides the size of the National Health Fund. Nineteen regions and the two autonomous provinces of Trento and Bolzano organise and run services. Local health authorities (ASL) and hospital trusts deliver care.
This shared model explains much of the policy debate. National reforms depend on regional implementation, and regional performance varies widely.
Ministry of Health, with ISS, AGENAS and AIFA. National planning, LEA, financing framework, medicines, public health rules.
Twenty-one regional and provincial health services. Organisation, budgeting, hospital networks, primary-care contracts.
Local health authorities (ASL), hospital trusts, research hospitals (IRCCS), GPs and paediatricians, Community Houses.
Financing
The National Health Fund.
The fund is the main source of financing for regional health services. It is set in each annual budget law and shared between regions under agreed criteria.
National Health Fund, € billion
Source: Minister of Health, statements on the 2026 budget. The Parliamentary Budget Office puts 2026 at €142.9bn, +€6.4bn on 2025.
The Minister has said that health resources have risen every year of the mandate, from about €126 billion in 2022 to nearly €143 billion in 2026. For the 2026 budget he announced €2.4 billion in additional financing.
The figures are disputed. Critics point out that part of the increase repeats sums already allocated in earlier budgets, and that health spending as a share of GDP remains below that of France and Germany. Government planning documents put total health spending in 2026 at about 6.5% of GDP.
The Minister has said he wants to change the terms of the debate: "It's not only about how much money," he said in October 2026, but how it is spent and what health results it achieves. The three priorities for new spending he has named are health personnel, waiting lists and prevention.
Policy file
Seven reforms, explained.
Waiting lists
Waiting times are the most visible failing of the SSN and the most common reason Italians turn to private care. Decree-Law 73 of 7 June 2024, converted into Law 107 of 29 July 2024, set out urgent measures. Article 1 created a National Platform for waiting lists to make regional performance comparable. Article 2 set up a body to verify and monitor how care is delivered.
Delivery has been slow. Some implementing decrees came late, and the GIMBE Foundation estimated that about 5.8 million people went without needed tests or visits in 2024. In October 2026 the Minister said that AGENAS data showed "first signs of improvement", while acknowledging that the problem cannot be solved "overnight".
Territorial and primary care
The pandemic showed how weak care outside hospitals had become. Mission 6 of the PNRR, worth €15.63 billion, funds a new tier of community care: Case della Comunità (Community Houses) where GPs, nurses and specialists work together, Ospedali di Comunità (Community Hospitals) for short intermediate stays, and Centrali Operative Territoriali (COT) to coordinate patients' movement between settings.
| Facility | Original target | Revised target | Change |
|---|---|---|---|
| Community Houses | 1,350 | 1,038 | −23% |
| Community Hospitals | 400 | 307 | −23% |
| Territorial operations centres | 600 | 480 | −20% |
The targets were reduced in the 2023 revision because construction costs had risen and timelines had slipped. The government said facilities removed from the PNRR would be financed from other sources. In October 2026 the Minister said that more than 1,200 Community Houses had opened nationwide. The challenge now is to staff them so they become, in his words, "the citizens' homes" where people can get care without going to an emergency department.
The health workforce
Italy has many doctors relative to its population but an ageing medical workforce, persistent shortages in emergency medicine and general practice, and relatively few nurses. Pay, working conditions and violence against health workers are recurring concerns of the professional unions.
The 2026 budget, as presented by the Minister, includes around 7,000 new hires, which he described as "the first important signal" of a multi-year effort. Admission to medical school was also reformed. From the 2025/26 academic year the national entrance test has been replaced by an open "filter semester" in chemistry, physics and biology, with places allocated on results. The reform was led by the Ministry of University and Research. Its first run produced low pass rates, and adjustments are under discussion.
Essential levels of care (LEA)
The LEA list the services the SSN must provide everywhere, free or with a co-payment. The current framework dates from the decree of 12 January 2017. Updating it is slow, because each new service must be costed and agreed with the regions.
In October 2026 the Minister announced the publication of the decrees updating the LEA: about 800 changes covering new services, therapies, diagnostic tests, neonatal and cancer screenings and prosthetic devices, backed by more than €150 million. "The new LEA will be the same across the entire national territory," he said.
Regional health systems
Regional autonomy allows innovation but also produces inequality. Regions in deficit are placed under recovery plans. Patients from the south often travel north for treatment, which moves money from poorer to richer regions.
The Minister has defended national standards while respecting regional responsibility. In December 2025 he said he was ready to use the State's substitutive powers to intervene directly in regions that failed to meet deadlines for opening Community Houses. He also announced direct intervention where waiting times were most serious.
Pharmaceutical policy
The reform of the Italian Medicines Agency merged its Technical-Scientific Committee and its Pricing and Reimbursement Committee into a single Scientific and Economic Committee. In his December 2024 message to AIFA, the Minister reported 158 pending procedures processed, 133 reimbursement applications completed, a 40% reduction in dossier submission deadlines and an 85% increase in renegotiation procedures.
Emergency preparedness
The Pandemic Plan 2025–2029, approved by the State–Regions Conference in April 2026, replaces the 2021–2023 plan with a five-year strategy for respiratory pandemics, whatever the pathogen. See Public Health.
Sources
- Decree-Law 7 June 2024, n. 73, converted by Law 29 July 2024, n. 107 (Gazzetta Ufficiale).
- Quotidiano Sanità, "Schillaci: Nuovi Lea uguali in tutta Italia…", October 2026. quotidianosanita.it
- Il Sole 24 Ore (English edition), interview with the Minister, 2 December 2025. en.ilsole24ore.com
- AIFA, "Message of the Minister of Health Orazio Schillaci to AIFA", 18 December 2024. aifa.gov.it
- Chamber of Deputies research service, "PNRR — Missione 6 Salute". temi.camera.it
- Quotidiano Sanità, "PNRR: dalla Commissione UE ok a revisione del piano italiano". quotidianosanita.it