Italian public and private health systems
When expatriating to Italy, it is important to be aware of the rules and customs concerning the Italian public and private health care systems. The Italian public health system is called Servizio Sanitario Nazionale (SSN) and it ranks 22nd in Europe, about ten places behind France. Expatriates in Italy will be able to choose between two types of health plans: the public health system, Assicurazione Generale Obbligatoria (AGO), or to complement it with a private health insurance. The quality of treatment and waiting times in the Italian public health system vary greatly from one region to another, which is why many expatriates choose to supplement their health coverage with private insurance. What are the characteristics of the health care systems in Italy? What are the differences between public and private health care systems? Lisbob, your expat assistant in Italy, answers all your questions on how to be treated and how to stay healthy.
Public Health System, SSN (Servizio Sanitario Nazionale)
The Italian health care system, the Servizio Sanitario Nazionale (SSN), is managed at the regional level and financed by the residents through taxes. Basic care is provided in local health units, formerly called USL for Unità Sanitaria Locale. From now on, the name of these centers will vary from one region to another: Azienda Sanitaria Locale (ASL), Azienda Unità Sanitaria Locale (AUSL) or Azienda USL, Azienda Sanitaria Provinciale (ASP), etc. At the national level, we usually call it ASL.
The care is provided by doctors who are either civil servants or private practitioners, but all of them have a contract. The insured person is free to choose the general practitioner, but a specialist can only be consulted with a prescription from the general practitioner. Hospitalization is free of charge in approved establishments but can only be done on the prescription of a general practitioner or a specialist. Of course, in case of emergency, it is possible to go directly to the hospital.
How to access this service
In order to benefit from the Italian health care system, you must register with the SSN. The first step is to go to the local health administration or Unità Sanitaria Locale of your place of residence. Each insured person will obtain a health card or Tessera Sanitaria.
Coverage and limitations
The Italian health care system offers universal coverage similar to that offered by the French social security system, for example. However, the Italian health care system has a number of weaknesses that are important to know and consider before moving to Italy.
The Italian SSN covers
General medical and dental care (some medical certificates are subject to fees) from registered practitioners;
Treatment by registered specialists (with a minimum contribution of 34 euros);
Hospital care in approved facilities;
Prescription drugs with a minimum contribution of 3.10 euros per prescription (be careful because some drugs are not reimbursed at all);
Partial coverage of certain services (prostheses, cures, laboratory tests, orthopedic care, etc.).
This is the health card, Tessera Sanitaria
Care is provided at regional health centers or by doctors licensed by the NHS. The insured has the possibility to choose his or her initial general practitioner and may change once a year at the most. If another doctor is chosen then the insured will not be reimbursed. There are public clinics and private establishments that offer specialized care, particularly dental and orthopedic care.
At first glance, the Italian public health system seems to be pretty good. Nevertheless it has a number of negative points such as
It is only possible to obtain a consultation with a specialist after a consultation with a general practitioner, thus lengthening the time required;
The insured can only choose a contracted practitioner, which can be restrictive;
Except for emergencies, admission to the hospital is by prescription from a general practitioner or a specialist under contract;
Waiting times in the public sector can be very long;
Due to the decentralization of the Italian health system, there are many inequalities between regions in terms of access and quality of care. Some hospitals are below the average quality standards (richer North and poorer South);
The care is not entirely free of charge and you will be asked to pay a minimum fee for each service or medication.
For all these reasons, a growing number of expatriates are using the private health care system as a complement or alternative to the public system.
Private health system
The private medical sector is highly developed in Italy. It is similar to what can be found in other European countries. In Italy, this private health care system makes it possible to deal with regional disparities and their consequences. As previously mentioned, the southern regions of Italy, including Sardinia, are the least well equipped in terms of quality of care. Many patients choose to seek treatment in the northern regions of the country, which considerably lengthens the waiting lists.
Choosing private health insurance will help you avoid waiting lists and access better quality care. Also, if you wish to visit a private specialist who is not covered by a convention, it will be very expensive: between 60 and 80 euros for a general practitioner and up to 150 euros for a specialist. A private health insurance plan will allow you to face this type of expense and to choose your practitioner in all serenity.
Another important point is hospitalization. If it is fully covered by the Italian public health system, you will have to pay for everything else, such as comfort and services. If you prefer to have a room to yourself, or to have a telephone, it is important to have a complementary private health insurance. The amount of your health insurance premiums will depend on the benefits you wish to receive as well as your level of risk (age, medical history, profession, hobbies), nothing too out of the ordinary.