How does healthcare in Italy work? Is it free? How do I use my Tessera Sanitaria? Stressed out already? We’ve picked the most confusing points in an attempt to guide you through the Italian Healthcare System.
Table of contents
Is healthcare good in Italy?
The average level of medical care is quite high compared to international standards, and Italian doctors are usually highly qualified. Life expectancy in Italy is among the highest in the OECD group of countries (Organisation for Economic Co-operation and Development). Check out the 2023 OECD report on healthcare in Italy, along with Italy’s rankings across various health-related reports:
1. Legatum Prosperity Index:
In the 2023 Legatum Prosperity Index, Italy ranks 17th in the Health Pillar, which evaluates countries based on factors such as healthcare infrastructure, health outcomes, and access to care.
2. CEOWORLD Magazine’s Health Care Index:
According to the 2024 CEOWORLD Health Care Index, Italy is ranked 22nd out of 110 countries. Notably, Italy scores 98.3 out of 100 for Medical Infrastructure and Professionals, placing it first in Europe in this category.
3. World Health Organization (WHO):
The WHO’s last comprehensive ranking of global health systems was published in 2000, where Italy was ranked 2nd overall. However, this ranking is now outdated, and no more recent comprehensive assessments have been released by the WHO.
Public healthcare in Italy
The Italian National Healthcare Service (SSN – Servizio Sanitario Nazionale) is a public, tax-funded system organized by the Ministry of Health and managed at the regional level. To access the SSN, you must hold a valid Tessera Sanitaria (Italian Health Insurance Card) or an equivalent card from another EU country, such as the EHIC (European Health Insurance Card) also known as TEAM (Tessera Europea Assicurazione Malattia) in Italy .
Foreign citizens with a valid residence permit (permesso di soggiorno) in Italy are entitled to the same healthcare rights and treatments as Italian citizens.
Public healthcare is delivered through regional health units with different names across Italy: ASL (Azienda Sanitaria Locale – Local Health Authority), USL (Azienda Sanitaria Locale – Local Health Authority), ULSS (Unità Socio-sanitaria – Local Health Unit) or and public hospitals. For example, in Rome alone, there are six public hospitals and over 50 ASL offices.
The ASL is the administrative body responsible for a network of public hospitals, clinics and services, including vaccination centers, walk-in clinics, labs for diagnostic tests and imaging, and more.
Primary care is provided through a system of general practitioners and pediatricians.
When you register with the SSN, you’ll be asked to choose your medico di medicina generale (MMG)—your assigned public primary care doctor. Once registered, you’re entitled to free consultations, referrals, and prescription refills through this doctor during their office hours.
ASL offices in Italy
Click to load the interactive map
Disclaimer:
This information has been compiled from publicly available sources for general use. Office addresses, opening hours, and service availability may change, and some offices may no longer be in operation. Please confirm all details directly with the relevant ASL office before your visit.
Private healthcare in Italy
Private healthcare in Italy, as in other countries, is provided at a fee.
In most cases you will be required to pay upfront for the services, installment payment options are usually available for larger sums (e.g. for hospitalisation or elective surgery). As a large percentage of Italians rely on Public Healthcare, Private medical services in Italy are rarely overcrowded and usually provide a more comfortable experience and a better customer care.
Medical fees in Italy are usually very reasonable, compared to other countries with similar cost of living.
Private hospitals in Italy often operate also in agreement with the Italian National Healthcare Service. When they do, they are in the category called Privato Convenzionato (Private with agreement). This means they can also be accessed with the Italian Health Insurance Card (Tessera Sanitaria), under certain conditions. If they have an Emergency Room (Pronto Soccorso) it is certainly accessible through Public Healthcare.
If you wish to access services at a Private clinic using your Tessera Sanitaria, you need to communicate this in advance, as there are dedicated slots for Public Healthcare. If you fail to communicate it in advance, you will be required to pay as a private patient.
How private healthcare spending works
Private healthcare in Italy is not just about wealthy people paying out of pocket. There are different types of private spending:
- Accredited private facilities – private hospitals and clinics that receive public funding to handle patient overflow from the public system.
- Out-of-pocket spending – when people pay for medical services directly, without any reimbursement.
- Private insurance spending – when companies, professional associations, or individuals buy insurance plans that cover private healthcare.
While out-of-pocket spending has increased, the overall balance between public and private healthcare hasn’t changed much.
In 2023, 17.5% of total healthcare spending went to accredited private providers, roughly the same as in previous years. Meanwhile, private out-of-pocket spending rose slightly, from €34.3 billion to €45.9 billion, but still only accounts for 2.3% of GDP.
What do you get with national healthcare registration?
When you register to the Italian Healthcare System you get your Tessera Sanitaria (Italian Health Insurance Card) and you are officially entitled to the same rights and duties regarding healthcare as Italian citizens. For example you can:
- Choose your public primary care physician or a pediatrician for your children (<14 y.o.)
- Get vaccinations
- See a specialist doctor (e.g. a gynecologist, a cardiologist, etc)
- Have lab tests and diagnostics (ultrasound, X-ray, etc)
- Get prescriptions for medications
- Be admitted to a Hospital
- Access life-saving treatments like chemotherapy for cancer.
What happens if you get sick in Italy?
The gatekeeper of the Italian Healthcare System is the public primary care doctor (Medico di Medicina Generale – MMG), also known as your medico di base.
If you’re registered with the National Healthcare System and have been assigned a primary care doctor, you can access many services either for free or with a minimal co-pay (ticket sanitario, see below), as long as you have a referral or prescription from your doctor.
Consultations with your assigned primary care physician (MMG) and with pediatricians (Pediatra di Libera Scelta) are always free of charge.
Hospital admissions are also free when you’re admitted for a necessary procedure. Elective procedures, such as preventive check-ups, are generally not covered, unless they are part of a special public health campaign (e.g. flu shot in Italy) aimed at preventing specific diseases of public interest.
Medical specialist visits, lab tests, and diagnostic exams come with a small co-pay, but costs remain very affordable through the public system (ticket sanitario). To access these services, you’ll need a referral—called an impegnativa—from your primary care doctor. This document confirms that the procedure is part of the National Healthcare Service.
Some medications are provided for free, especially those prescribed for serious or life-threatening conditions. Others are available at a reduced price if you have a prescription (once known as ricetta rossa) issued by your assigned doctor.
What is a Tessera Sanitaria and how do I get one?
The Tessera Sanitaria (Italian Health Insurance Card), also known as the “TEAM” card, is Italy’s version of the European Health Insurance Card (EHIC) and the most important document for accessing public healthcare in Italy and across Europe.
It’s the proof you’re registered with the public National Healthcare System in Italy (SSN – Servizio Sanitario Nazionale). It is required for anyone using the Italian National Health Service . You’ll need to show it when visiting a public doctor, buying medication at a pharmacy, getting blood tests, undergoing specialist exams or diagnostics, or being admitted to a public hospital.
However, the Tessera Sanitaria is not needed if you’re seeing a private doctor—whether a general practitioner or a specialist—or if you’re buying medication or getting blood tests based on a private prescription.
Foreign citizens from outside the European Union can register with the Italian National Health Service (SSN – Servizio Sanitario Nazionale) under two different categories:
Mandatory (or by-rights) registration is free and applies to those staying in Italy for reasons such as work, family, international protection, pregnancy, fostering, or adoption.
Voluntary (or optional) registration is available to others—such as students, au pairs, and religious staff—who are staying for more than 90 days. This option requires paying an annual lump sum. Notably, students and au pairs can also choose to register even if their stay is under 3 months.
Tourists, however, cannot register with the Italian National Health Service.
| Country | Local Name for EHIC |
|---|---|
| Austria | Europäische Krankenversicherungskarte (EKVK) |
| Belgium | Carte européenne d’assurance maladie / Europese ziekteverzekeringskaart |
| Bulgaria | Европейска здравноосигурителна карта |
| Croatia | Europska kartica zdravstvenog osiguranja |
| Cyprus | Ευρωπαϊκή Κάρτα Ασφάλισης Ασθένειας |
| Czech Republic | Evropský průkaz zdravotního pojištění |
| Denmark | Det blå EU-sygesikringskort |
| Estonia | Euroopa ravikindlustuskaart |
| Finland | Eurooppalainen sairaanhoitokortti |
| France | Carte européenne d’assurance maladie (CEAM) |
| Germany | Europäische Krankenversicherungskarte (EHIC) |
| Greece | Ευρωπαϊκή Κάρτα Ασφάλισης Ασθενείας |
| Hungary | Európai Egészségbiztosítási Kártya |
| Ireland | European Health Insurance Card (EHIC) |
| Italy | Tessera Europea di Assicurazione Malattia (TEAM) |
| Latvia | Eiropas veselības apdrošināšanas karte |
| Lithuania | Europos sveikatos draudimo kortelė |
| Luxembourg | Carte européenne d’assurance maladie / Europäesche Gesondheetskaart |
| Malta | Karta Ewropea tal-Assigurazzjoni tas-Saħħa |
| Netherlands | Europese zorgpas / Europese ziekteverzekeringskaart |
| Poland | Europejska Karta Ubezpieczenia Zdrowotnego (EKUZ) |
| Portugal | Cartão Europeu de Seguro de Doença (CESD) |
| Romania | Card european de asigurări sociale de sănătate |
| Slovakia | Európsky preukaz zdravotného poistenia |
| Slovenia | Evropska kartica zdravstvenega zavarovanja |
| Spain | Tarjeta Sanitaria Europea (TSE) |
| Sweden | Europeiska sjukförsäkringskortet |
Is healthcare free in Italy for foreigners?
Healthcare in Italy is not free, but the fees are usually quite reasonable and emergency medical assistance is provided to anyone in need, regardless of their nationality, without asking for upfront payment.
Healthcare in Italy is provided to anyone with a mixed public and private system (Servizio Sanitario Nazionale or SSN in Italian). Italian law recognizes health as a fundamental right of every person and anyone present in Italy is entitled to a form of healthcare (a concept known as “Universal Health Care“).
In a country with universal healthcare, like Italy, everyone helps pay for it through taxes collected by the government.
Italy has universal healthcare coverage, but only some services are completely free
Most services demand a co-pay and many services are provided at the patient’s full expense.
The co-pay fee is called “Ticket sanitario”, or simply “Il ticket”, and it is applied to some emergency room visits, specialist consultations, diagnostic procedures and lab analyses.
The co-pay amount depends on the type of service needed and the patient’s status—there are exemptions for low income or serious illnesses. It used to vary by region, but this has recently changed.
How much does it cost to see a doctor in Italy as a foreigner?
Costs of public healthcare doctor visits in Italy for foreigners
There are four types of foreign visitor status that affect healthcare costs in Italy.
- Foreigners with a valid residence permit and registered with the Italian National Health Service (SSN)
- Foreigners not registered with the SSN but coming from EU member states, the European Economic Area (EEA – i.e. Iceland, Liechtenstein, and Norway), or the Swiss Confederation.
- Foreigners not registered with the SSN, coming from countries outside the European Union, the European Economic Area, or the Swiss Confederation, with which Italy has bilateral agreements or conventions for healthcare based on reciprocity.
- Foreigners not registered with the SSN and not coming from any of the countries mentioned above.
1. Foreigners with a residence permit and SSN registration.
Emergency room visits, urgent hospital admissions, outpatient care, and scheduled hospitalizations are charged the same as they are for Italian citizens.
2. Non-SSN-registered foreigners from EU, EEA, or Switzerland.
- With EHIC/GHIC: same cost as Italian citizens
- Without EHIC/GHIC, they must pay the full cost of medical services in Italy.
Outpatient care and scheduled hospitalizations:
- If EHIC/GHIC is presented along with an S2 form: same cost as Italian citizens
- Without EHIC/GHIC and/or S2 form: they must pay the full cost of medical services in Italy. Payment of the full costs of care based on a prior cost estimate
3. Non-SSN-registered foreigners from non-EU/EEA/Swiss countries with bilateral healthcare agreements with Italy.
Citizens of countries that have signed a bilateral agreement or convention with Italy, staying temporarily in the country.
(Argentina, Australia, Bosnia and Herzegovina, Brazil, Cape Verde, Vatican City, North Macedonia, Montenegro, Monaco, San Marino, Serbia, Tunisia).
Emergency room visits and urgent hospital admissions:
- Upon presenting a certificate from their country of origin: same cost as Italian citizens
- Without certificate, they must pay the full cost of medical services.
Outpatient care and scheduled hospitalizations:
- Upon presenting a certificate from their country of origin: same cost as Italian citizens
- Without certificate: they must pay the full cost of medical services.
4. Non-SSN-registered foreigners from non-EU/EEA/Swiss countries without bilateral agreements.
Tourists from outside the European Union, as well as non-EU foreigners who are not registered with the Italian National Health System (SSN), must pay the full cost of medical services—this includes emergency room visits and urgent hospitalizations. They are also required to cover the costs of outpatient care and planned hospital admissions, usually based on a prior cost estimate.
In addition, non-EU patients who visit the emergency room must reimburse the cost of any medications, medical devices, or supplies that are not included in the standard outpatient service fee—unless otherwise covered by international agreements.
Tourist paying for healthcare isn't new
The idea that non-EU tourists now have to pay for medical care in Italy might sound like a big change—but it’s not new at all.
In fact, it’s been part of Italian law for over two decades. The requirement for foreigners to have health insurance when visiting Italy was reaffirmed by Interministerial Decree No. 850 of May 11, 2011, which simply updated an earlier rule from 2000. That original rule was already aligned with an EU directive from 2003. So, what’s being framed as a “revolutionary” policy is really a rule that’s been in place for 24 years.
Someone have suggested that the law exists but isn’t enforced. That’s not quite accurate either. Italian embassies won’t issue a tourist visa unless the applicant provides proof of health insurance—this is a strict and consistent requirement. Anyone familiar with the process knows embassies take this very seriously.
There is one exception worth noting: citizens from countries with visa waiver agreements. These travelers can enter Italy for short stays without applying for a visa, so they don’t go through the embassy system. At the border, they may be asked to show proof of insurance—but in practice, this check is often relaxed. These visa-exempt countries typically have strong diplomatic or economic ties with Italy—examples include Canada, the UAE, Israel, Monaco, the UK, and the US.
Italy’s healthcare co-pays ("ticket") have recently changed: here’s what you need to know for 2025
A “ticket sanitario”, or simply “ticket”, is a co-payment that patients contribute when receiving non-urgent medical care, like specialist visits, blood tests, or diagnostic exams.
While access to the Servizio Sanitario Nazionale (SSN) is largely subsidized, most people still pay a small fee unless they qualify for exemptions based on income, age, or chronic conditions.
Until now, these co-pays have varied widely across Italy, depending on the region. But that’s finally about to change.
After years of debate and delays, Italy has implemented a unified national tariff system starting January 1, 2025. This reform means that for the first time in decades, the same exam will cost the same across all regions of Italy — from Milan to Palermo.
While the national tariff list was set to go live on December 30, 2024, regions have the option to continue applying old tariffs for up to 18 months, especially for prescriptions issued in late 2024.
Also, private labs — which often provide services on behalf of the SSN (which is called privato accreditato in Italian) — have raised concerns that the new prices are too low to be sustainable, especially for smaller providers.
Legal challenges may continue, but for now, the unified ticket system is moving forward.
Why the change?
In 2017, Italy redefined its Essential Levels of Care (LEA) — the minimum healthcare services guaranteed to all residents. But these remained largely theoretical without updated pricing. Different regions set their own tariffs and added services over time, creating 21 different regional systems with inconsistent co-pays.
The new national tariff list standardizes over 2,000 medical services, finally bringing the LEA into full effect.
What will the new co-pays be in 2025?
First Specialist Visit
New flat rate: €25 nationwide
Current variation: €20.5 in some regions to €36.15 in others
Note: Some specialties will have specific rates.
- Cardiology visit: €34 (includes ECG)
- ENT visit: €26.20
Follow-Up Visit
New rate: €17.90
Current range: €12.91 to €25 depending on region
Electrocardiogram (ECG)
Remains at: €11.62
No change, as most regions already charge this amount
Chest X-Ray
New flat rate: €15.45
Savings: Up to €10 in regions like Tuscany, Veneto, and Friuli
Abdominal Ultrasound (Lower Abdomen)
National rate: €37.80
But: What you pay still depends on your region’s maximum co-pay cap (see below)
The maximum co-pay per prescription
Italy caps the amount you can be asked to pay per medical prescription — even if multiple tests or visits are included.
- Standard cap: €36.15 in most regions
- Higher caps: Lazio, Campania, Calabria, Sardinia, and Marche — up to €46.20
- If you’re exempt (e.g. due to income or chronic illness), you pay nothing.
📝 Example: If your prescription includes an exam that costs €50, you’ll still only pay €36.15 if you’re in a standard-cap region. The rest is covered by the SSN.
What else is changing in the Italian healthcare system in 2025?
The updated LEA list includes new services and technologies, such as:
- Assisted reproduction (PMA) offered across the country
- Genetic counseling and testing for hereditary diseases
- Advanced diagnostics, like:
- Capsule endoscopy (i.e. enteroscopy with ingestible camera)
- Stereotactic radiotherapy
- Proton/adron therapy
Many of these services were previously unavailable or inconsistent across regions.
Limits of public healthcare in Italy
As with all things free, there’s a flip side. To avoid disappointment, keep in mind that:
Your primary care physician – though part of the Italian NHS, is self-employed – and will only be available during pre-set office hours, which vary from doctor to doctor. House calls are rarely offered and only in cases of clear medical necessity.
The doctor’s office may be crowded, and doctor appointments are usually not available—patients are typically seen in the order of arrival. If the waiting room is full, you may be asked to return another day.
Most general practitioners working within the Italian National Healthcare Service do not speak English. If you don’t speak Italian, communication may be difficult.
Hospitals can be large and disorienting. Even with an appointment, you might find yourself wandering around looking for the right department—or waiting longer than expected.
For non-urgent diagnostic procedures or specialist visits through the SSN (Servizio Sanitario Nazionale), wait times can be long—sometimes weeks or even months.
You cannot choose your doctor when referred to a specialist. You’ll be assigned to whoever is available at the time of your appointment, within the relevant specialty.
The long wait for medical appointments in Italy
Trying to book a mammogram in many Italian regions? You might be told the first available slot is two years away. Need an ultrasound? Be prepared to wait over a year. Even a dermatology appointment can take 300 days.
These delays aren’t just for a few specialties—MRIs, eye exams, and many other essential medical services also have long waiting times, often making priority requests useless because hospitals are already at full capacity.
A recent report from Bocconi University identified five possible outcomes for someone who needs a doctor appointment:
- They are classified as high priority and get an appointment quickly.
- They return to their doctor and get a new prescription marked as “urgent” to speed up the process.
- They wait months (or years) for their appointment, far beyond the recommended timeframe.
- They turn to private healthcare to get seen faster.
They give up and don’t get care at all. (In 2023, 4.5 million Italians were forced into this category—2.5 million of them due to financial reasons).
Why are wait times so long?
The issue isn’t new.
Cittadinanza Attiva, a healthcare watchdog, tracks healthcare access every year and has long highlighted the problem.
While the COVID-19 pandemic made things worse, wait times were already a serious issue well before. Politicians frequently promise solutions, but so far, no one has succeeded in fixing it.
One challenge is confusion between “waiting lists” and “wait times.”
- Waiting list = the number of people in line.
- Wait time = how long it takes to get an appointment after booking.
- Uneven healthcare availability across regions
- Hospitals with different internal rules
- A mix of public and private services with different priorities
- Emergency situations that disrupt normal scheduling
To tackle the issue, the government introduced a priority system in 2019:
- U (Urgent): Within 72 hours
- B (Short-term): Within 10 days
- D (Deferrable): Within 30 days
- P (Planned): Within 120 days
The role of private healthcare
To bypass public healthcare delays, some patients turn to private providers, which:
- Have shorter wait times due to more flexible scheduling
- Focus on more profitable procedures
- Are more integrated with public healthcare in the north but replace failing public hospitals in the south
There’s also intramoenia, where public hospital doctors offer private appointments within the hospital after hours. This system was meant to reduce reliance on private clinics, but in many hospitals, intramoenia visits now outnumber public ones.
By law, if public hospitals can’t meet wait time limits, patients should be able to book intramoenia appointments at public rates.
The Consequences of Long Wait Times
- 11% of Italians skipped needed exams in 2021 due to cost or access issues.
- 2 million people (3.3% of the population) gave up care due to wait times.
- Delays lead to preventable deaths, as conditions go undiagnosed and untreated.
Why More Italians Are Skipping Medical Care – And Why It’s Hard to Fix
In Italy, more and more people are giving up on medical care because appointments take too long or healthcare costs are too high. This growing issue, known as healthcare abandonment, has been a major topic of discussion among doctors and health experts—especially since COVID-19.
Skipping medical care is a key indicator of how well the healthcare system is working. If people are forced to delay or avoid care, their health worsens, leading to more serious (and costly) problems later.
However, getting reliable data on this issue is difficult.
One of the few comprehensive studies comes from ISTAT (Italy’s National Institute of Statistics), which includes healthcare accessibility in its “Fair and Sustainable Well-being” (BES) survey—a broader report covering work, education, and public services.
How big is the problem? (2023 data)
The latest ISTAT data, released in March 2024, shows that:
- 4.5 million Italians skipped needed medical care in 2023 due to cost, long wait times, or difficulty reaching hospitals and clinics.
- This is 372,000 more people than in 2022.
- The percentage of Italians who gave up on care rose from 7% to 7.6% of the population.
- 4.5% of Italians specifically skipped care due to long wait times—a doubling of the problem since 2019.
- 4.2% skipped care because they couldn’t afford it.
Understanding prescription appropriateness and medication use in Italy
What is prescription appropriateness?
Prescription appropriateness means that a medication is prescribed only when necessary and used correctly—in the right dose and duration—for conditions where it has been proven effective. Healthcare systems monitor prescription patterns to ensure doctors and patients follow these principles, using data to track whether medications are being used appropriately.
Cardiovascular disease & blood pressure medication
Cardiovascular diseases are the leading cause of death in Europe, accounting for 43% of male and 55% of female deaths. In Italy, the financial burden of these diseases—covering medical costs and lost productivity—amounts to €293 per person per year, about 15% of total healthcare spending. However, 80% of heart disease cases before age 75 are preventable.
The main risk factor is high blood pressure (hypertension), which can lead to heart attacks, strokes, and kidney failure. Managing blood pressure with consistent medication use is one of the most effective ways to reduce cardiovascular risk.
- 27% of Italians (16 million people) have hypertension.
- 64.7% of them have no other chronic conditions.
- Only 53.7% take their medication consistently, with adherence lower in the South (50.8%) than in the North (54.2%) and Center (55.3%).
- Men (55.5%) are slightly more consistent than women (52.3%) in taking blood pressure medication.
Adherence to treatment improves with age, multiple prescriptions, or previous heart disease/diabetes diagnoses.
Antidepressant use & depression management
- Higher rates of depression, anxiety, and panic disorders.
- Newer, more user-friendly antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors).
- 12.1% of Italians (7.2 million people) experience major depression, but only 34.9% take antidepressants.
- Adherence to treatment is low, with only 37.7% of patients staying on antidepressants long enough to be effective.
- 50% of patients quit within 3 months, and over 70% stop within 6 months, despite recommendations for a minimum 6-month treatment to prevent relapse.
- Southern Italy has the lowest adherence (29.5%), compared to the North (40.0%) and Center (39.7%).
Younger patients and men are less likely to stick to treatment. About 25.8% of users take antidepressants only occasionally, with the highest rates among those under 45 and in the South.
Respiratory disease medications (asthma & COPD)
- 6.3% of Italians have asthma, while 3.1% have COPD.
- Only 14.9% of patients consistently take their prescribed respiratory medications, and adherence is declining.
- The youngest age group (under 45) has the lowest adherence (5%).
- Men (18.6%) are more likely to follow treatment than women (12.0%).
Additionally, 60% of patients use these medications only occasionally, which may reduce their effectiveness.
Antibiotic overuse & resistance
Antibiotic consumption is a critical factor in the development of antimicrobial resistance (AMR), a significant global health concern.
Estimates suggest that approximately 66% to 70% of all antibiotics are used in animals rather than humans so the biggest danger presumably isn’t prescription-happy GPs.
While there have been some efforts to curb antibiotic use in agriculture, most policies and public awareness campaigns still focus primarily on human consumption.
Antibiotics are often overprescribed for respiratory infections and urinary tract infections (UTIs), even when they are not needed.
- 80% of respiratory infections are viral, meaning antibiotics won’t help.
- Fluoroquinolone antibiotics are often misused for simple UTIs, despite guidelines advising against them.
-
Over 20% of antibiotic prescriptions are inappropriate, with the worst cases being:
- Laryngotracheitis (48.6% inappropriate use)
- Uncomplicated cystitis (37.0% inappropriate use)
Inappropriate antibiotic use contributes to antibiotic resistance, making infections harder to treat in the future.
Italy’s “gig economy” doctors: a crisis in public healthcare
In late 2024, the tragic death of a 14-year-old girl in northern Italy has reignited a heated debate about “medici gettonisti” —freelance physicians hired by public hospitals through private staffing agencies.
These doctors are paid by the hour, often without proper training in emergency medicine, and are increasingly relied upon by Italy’s struggling public healthcare system.
A case that shocked the country
A young girl was hit by a car while riding her bike to catch a bus in Sant’Angelo di Piove di Sacco (Padua).
She was taken to the hospital, but the emergency doctor who treated her is now under investigation after two nurses claimed she failed to perform the necessary resuscitation procedures.
The doctor was not an employee of the hospital but worked for a private company that supplies doctors to hospitals in need.
She was a nephrologist (kidney specialist), not an emergency doctor, and may not have been qualified to handle such a critical case.
According to the nurses present, the doctor froze under pressure and admitted she didn’t know how to perform resuscitation.
She is now facing criminal charges for neglect of duty, disrupting essential public services, and manslaughter through negligence.
Who are the “Medici Gettonisti”?
The term “gettonisti” refers to freelance doctors who are hired through private agencies and paid per shift rather than being employed directly by hospitals.
The shortage of doctors and nurses in Italy’s public hospitals has led to an increasing reliance on these temporary medical staff. Some hospitals have even recruited doctors from abroad—such as Cuban doctors in Calabria—while others, particularly in northern Italy, depend heavily on gettonisti supplied by staffing agencies.
Since the pandemic, the use of gettonisti has exploded. These doctors are now a regular part of hospital operations, and many argue there’s no going back—especially since working as a gettonista is far more lucrative than a permanent hospital job, which comes with long hours and low pay.
Why Is this a problem?
Lack of training & oversight
Unlike full-time public hospital doctors, gettonisti don’t go through a strict hiring process.
Many lack specialization in the areas where they are assigned.
In emergency rooms, obstetrics, and critical care, doctors without the proper training are making life-or-death decisions.
A 2022 investigation by Italy’s health authorities found that many freelance doctors working in ERs had no emergency medicine training, and some obstetricians couldn’t perform C-sections.
Excessive work hours & fatigue
Full-time hospital doctors are limited to 48 hours per week under EU law.
Gettonisti have no such limits—some work back-to-back shifts for days to maximize earnings.
Who checks if a doctor starting a night shift has already worked 24 hours straight?
Sky-high pay for freelancers, low pay for full-time doctors
A gettonista doctor earns €90-100 per hour—as much as a full-time public doctor earns in an entire day.
Some gettonisti make €800-900 per day—three times what a senior hospital doctor with 15 years of experience earns.
A 12-hour shift for a gettonista pays as much as an entire week’s salary for a regular hospital doctor.
“I used to work 80-90 hours a week as a public hospital doctor for low pay. Now, as a gettonista, I earn the same in a single shift and have control over my schedule.” – Anonymous freelance doctor
No patient-doctor continuity
Full-time doctors follow their patients over time, tracking their treatments and health progress.
Gettonisti work short-term shifts in different hospitals, meaning patients see a new doctor every time.
This hurts continuity of care and leads to miscommunication in treatment plans.
Hospitals take the legal & financial risk
Gettonisti are contracted through private agencies.
If something goes wrong, the public hospital—not the private company—is legally responsible.
Hospitals must pay for malpractice lawsuits and patient compensation, further draining already struggling public healthcare budgets.
Why are so many doctors becoming gettonisti?
Public hospitals are understaffed, overcrowded, and underfunded.
The stress, long hours, and low pay in public hospitals push doctors to quit.
A recent doctors’ survey found that 37.6% of hospital doctors are considering leaving their jobs to become freelancers instead.
A healthcare system in crisis
Italy’s public healthcare system has been weakened by years of funding cuts. Hospitals are overloaded, ERs are overflowing, and doctors face constant burnout.
Medical resignations have skyrocketed, with 8,500 doctors quitting public hospitals in the past four years.
In many cases, emergency rooms simply can’t function without gettonisti.
Hospitals are now dependent on gettonisti
Many hospitals now rely on staffing agencies to fill ER shifts for the next two to three years.
A recent report to Parliament revealed a 47% increase in private-sector hiring of medical staff between 2019 and 2022.
Some regions have tried to ban the practice, but courts have blocked these bans after lawsuits from private staffing agencies.
A possible solution
In 2025, Italy will remove the cap on public hospital hiring, allowing more doctors to be hired permanently.
However, there’s no guarantee more funding will follow, and many doctors have already lost faith in the public system.
Why are emergency rooms overcrowded in Italy?
ER overcrowding: a growing crisis in Italy
When the emergency room isn’t just for emergencies
In a typical day a medium ER can treat up to 500 people. That might not sound unusual, but here’s the catch: most of them aren’t in critical condition.
ERs are designed to handle severe and complex cases, yet most patients received a 4 or 5 code, meaning their conditions are minor and didn’t require emergency care. Think persistent flu symptoms or mild injuries—cases that should be handled by family doctors or urgent care clinics instead of an ER.
The result? Long wait times, overcrowded departments, and overworked medical staff.
When real emergencies compete with non-urgent cases
On the same day, several patients can arrive in critical condition (code 1). These life-threatening cases are often overshadowed in public discussions, lost in the noise about long wait times.
Why are people in Italy going to the ER for minor issues?
Skipping the family doctor
Many patients head straight to the ER without consulting their doctor first. Reasons include lack of awareness, convenience, and difficulty booking appointments.
A struggling primary care system
Family doctors and urgent care services are overwhelmed or unavailable, leaving hospitals as the only option.
Not enough hospital beds
Even patients needing admission often wait hours—or days—on stretchers or in hallways due to lack of available beds.
Staff shortages
Hospitals across Italy face a critical shortage of doctors and nurses, worsening ER wait times and care quality.
How big is the problem?
According to Agenas, Italy’s health agency, 51.7% of ER visits in 2021 were non-urgent.
In Bolzano, there were 121 non-urgent ER visits per 1,000 residents in a single year. Hospitals in Turin report similarly high levels of unnecessary visits.
A system designed for prioritization: how triage works
The old color code system
- Red: Immediate danger to life – treated immediately
- Yellow: Serious but not life-threatening – seen quickly
- Green: Minor emergency – can wait
- White: Not urgent – should seek care elsewhere
The new 5-Level system (since 2019)
- Emergency (red): Immediate care
- Urgent (orange): Treatment within 15 minutes
- Semi-Urgent (blue): Within 1 hour
- Minor Urgency (green): Within 2 hours
- Non-Urgent (white): Within 4 hours
Hospitals aim to treat patients within 8 hours, but many wait far longer.
The real problem: Italy’s healthcare system Is pverwhelmed
Primary care Is disappearing
Many family doctors have retired and haven’t been replaced. Booking a phone appointment is difficult in some regions, leading to ER visits for manageable conditions like diabetes or hypertension.
Patients are losing faith in family doctors
A study in Lecce found that 63.7% of ER patients didn’t consult their doctor first. Nearly half believed hospitals were the only place to find specialists and equipment. Many didn’t even know how to reach a doctor after hours.
Overcrowding is more than just an inconvenience
The boarding crisis
When patients can’t be admitted, they stay in the ER. Ideally, they should wait no more than six hours. In reality:
- 800,000 patients stay in ERs for at least two days each year
- 18,000 elderly patients die on hospital stretchers annually while waiting for a bed
“We handle over 20 million ER visits a year, but we’re also running ghost hospital wards for patients who have nowhere else to go.” – Fabio De Iaco, ER director, Turin
Not enough beds, not enough doctors
In the last 10 years, Italy has cut 30,500 hospital beds—a 19% drop in acute-care capacity. Regions like Molise, Calabria, Puglia, and Liguria have lost more than 25% of their beds.
Meanwhile, emergency rooms struggle to attract new doctors. Half the training spots for ER specialists remain empty.
Why?
- Low pay
- High stress
- Grueling hours (nights, weekends, constant overcrowding)
“ER doctors work five night shifts a month, three weekends out of four, and deal with constant overcrowding,” says Andrea Bellone, member of Italy’s emergency medicine committee. “It’s only getting worse.”
What needs to change?
There’s no quick fix, but experts agree on a few key priorities:
- Invest in primary care – Hire more family doctors and expand urgent care options.
- Increase hospital staffing – More doctors and nurses to reduce wait times.
- Expand hospital capacity – Italy has one of the lowest hospital bed ratios in Europe.
- Improve public awareness – Help patients understand when and where to seek care.
- Manage chronic illnesses early – Prevent complications that lead to ER visits.
Without these changes, the crisis will continue to escalate—especially with an aging population needing more care.
Frequenly asked questions about healthcare in Italy
Online doctors in Italy
How do I see a public primary care physician in Italy?
If you are registered with the Italian National Healthcare Service (SSN – Servizio Sanitario Nazionale), you have also selected your public general practitioner (medico di medicina generale – MMG), the doctor who is in charge of your health.
- You can visit this physician during their declared working hours.
- You can call to request a house visit if you’re unable to leave your bed.
- Family medicine and pediatrics
- Out-of-hours medical service (Continuity of care)
- Nursing services
- Blood tests and vaccinations
- Centralized booking center (CUP – Centro Unico di Prenotazione)
- Administrative services
- Social support services
- Volunteer activities
If you’re not registered with the SSN or you can’t register because you are a tourist, and need to see a doctor in Italy, you can use Doctorsa.
It’s an online urgent care service designed for travelers, connecting you with local primary care doctors. English-speaking doctors are available for video consultations in just minutes, starting from €20.
Here are some common medical issues that can be treated through online urgent care.
- Prescriptions when your medication is lost or runs out.
- Urinary Tract Infections (UTIs)
- Respiratory Infections (colds, sinus infections, mild asthma)
- Strep Throat and Tonsillitis
- Allergies and Hay Fever
- Skin Conditions (rashes, eczema, acne)
- Gastrointestinal Issues (diarrhea, nausea, acid reflux)
- Bed bugs bites
- Tick bite
- Jellyfish sting
- Eye Infections (conjunctivitis or stye)
- Headaches and Migraines
- Minor Injuries (sprains, strains)
- Sexual Health Concerns (Chlamydia treatment, birth control)
View the complete list of conditions treatable online.
Will any doctor in Italy accept my Tessera Sanitaria?
I need to see a doctor when my primary care physician is not available
- During nights (8pm–8am), weekends, or when you’re in another city, you can use the servizio di continuità assistenziale (Healthcare Assistance Continuity Center).
- You’ll be seen by an Italy NHS doctor for prescriptions, consultations, or minor wound care.
- May require a fee depending on local regulations.
- Phone consultations are available, but English may not be spoken.
I’m a European citizen traveling to Italy. Do I get free medical assistance?
As a EU Citizen or permanent resident, you should have your EHIC (European Health Insurance Card).
The EHIC card gives you access to Healthcare in Italy as if you were an Italian resident.
You will have free access to public primary care physicians, emergency rooms (for emergency only!) and discounted access to specialists and diagnostic procedures, if prescribed by a Doctor within the Italian Healthcare System (SSN – Servizio Sanitario Nazionale). For outpatient care and scheduled hospital admissions, in addition to the EHIC card, you will also need to provide a S2 form.
With the EHIC card, you have access to the same benefits of an Italian citizen holding the local Italian Health Insurance Card (Tessera Sanitaria).
Do they have urgent care in Italy?
- Urgent care walk-in clinics are uncommon in Italy.
- Most people see their designated primary care physician the same day.
- Shifting staff at urgent care centers makes it hard to find English-speaking doctors.
Healthcare in Italy for tourists
How can I see a private doctor?
Can pharmacists prescribe in Italy?
How to get antibiotics in Italy?
To get antibiotics in Italy, you’ll need a medical prescription issued by a doctor licensed to practice in the country. Pharmacists are not allowed to dispense antibiotics without it. This regulation is in place to prevent the overuse of antibiotics and combat the growing problem of antimicrobial resistance.
If you need a prescription quickly, you can speak to a doctor online and get one in minutes through online urgent care services like Doctorsa.
Can you get antibiotics over the counter in Italy?
No. Antibiotics require a valid prescription.
How do I get a prescription filled in Italy?
Bring a valid prescription (in-person or telemedicine) to any pharmacy and a valid ID.
Can I get a prescription issued in Italy, filled in another country?
How much does a prescription cost in Italy?
I need to see a medical specialist
First of all, are you sure you really need to see a specialist?
If you need to see a specialist quickly, your NHS doctor can mark the prescription as urgent, requesting an appointment within 10 or 30 days. This gives you access to priority slots reserved for urgent cases.
Once you have the referral (impegnativa), you can book your appointment:
Online (in some regions, like Lazio, where family doctors are integrated into the system),
By calling the regional CUP (Centro Unico di Prenotazione – the central booking office; for Lazio, the number is 803333), or
By contacting a hospital’s CUP directly.
Keep in mind:
You’ll likely need an Italian friend to help with the booking, as there’s no English-speaking operator or translation service.
You cannot choose your provider—you’ll be assigned the earliest available doctor appointment in the system.
Where can I go if I need blood tests, x-ray, or other diagnostic procedure?
The process is similar to seeing a specialist, and you have a few options:
Public hospital or clinic – You’ll need a lab order (paper prescription or ricetta elettronica) from your public primary care doctor or a public medical specialist.
Private hospital, clinic, or lab with an agreement with the National Health Service (SSN) – You must bring a lab order from your public primary care doctor or a public specialist. It should clearly state that the procedure is to be done within Italy healthcare system (paziente SSN). Without it, you may be charged as a private patient.
Private medical center, clinic, or lab – You can also choose to go fully private. Just check in advance that they offer the test or procedure you need.
Test results are typically uploaded to your Fascicolo Sanitario Elettronico (Electronic Health Record) and can be accessed through the official regional app.
What do I do if I need emergency medical assistance or if I have an accident?
- Go to the nearest Pronto Soccorso (ER) or call 112.
- Medical info will be requested at 118. If needed, an ambulance or helicopter will be dispatched.
- Triage determines treatment order based on urgency.
- ERs are not for minor ailments—alternatives should be used for those.
- Hospital stays are free with an EHIC or Tessera Sanitaria.
- Private rooms or transfers to private hospitals are available for a fee.
- Doctor qualifications are the same in public and private hospitals.
