Overview

Italians can expect to live long lives but changes in health behaviours can further lower morbidity and mortality

Life expectancy has continued to increase and reached 83.6 years in 2019 but fell temporarily in 2020 because of the number of deaths due to COVID-19. The main causes of death in Italy are cardiovascular diseases and cancer, like in most other high-income countries, and as of 2020, infectious respiratory disorders. Regional differences in health indicators are marked and behavioural risk factors such as dietary habits, alcohol and tobacco consumption are major drivers of morbidity: they account for about one-third of all deaths.

The regions are responsible for financing, planning, and delivering health services

The National Health Service in Italy (SSN) is highly decentralised, and each region is in charge of organizing and delivering health services to the population. The central government sets the national benefits package and allocates funding for the regional health systems. During the COVID-19 pandemic, there was centralization of power in terms of leadership and administration but implementation was largely left to the regions.

While health spending is relatively low, out-of-pocket expenditure has increased in recent years

At 8.7% of GDP in 2019, health expenditure in Italy is lower than in other Western European countries. In 2019, about 74% of total health expenditure was funded by public sources, and most of the remaining expenses (23%) came from out-of-pocket payments by households. Over the past ten years, the percentage of private health spending has increased, with direct out-of-pocket household expenses, rather than co-payments, accounting for the majority of this growth, raising concerns about the adequacy of financial protection. Nevertheless, given the level of health spending, the Italian SSN has been generally effective in providing access to high-quality care at a reasonable cost, despite significant regional variations.

Key areas of reform include prevention, hospital care, re-defining the national benefits package and monitoring

Recent policy initiatives have included expanding vaccination coverage, restructuring hospital provision and improving its care standards, revising the benefits package and implementing health system performance monitoring systems. Major challenges for the health system are linked to addressing historic underinvestment in the health workforce, modernizing outdated infrastructure and equipment, and enhancing information infrastructure. The Italian government plans to use its EU-funded National Recovery and Resilience Plan to strengthen primary and community care by investing in facilities, improve the SSN digital infrastructure, upgrade medical equipment, as well as for the training of health professionals.