You are about to land in Rome, at the end of a long flight, ready to enjoy the city tours and the local Dolce Vita.
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.
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. 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“).
The average level of medical care is quite high compared to international standards (Italian healthcare system ranked 2nd best in terms of performance in the World according to the World Health Organization’s report), 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). See the 2017 OECD report about healthcare in Italy.
Italy has universal healthcare coverage, but only some services are completely free
Most services demand a cost-sharing and many are provided at the patient’s full expense.
The co-pay fee is called “Ticket” and it is applied to some emergency room visits, specialist consultations, diagnostic procedures and lab analyses.
The amount of the co-pay is different from region to region and it depends on the type of services required and on the patient’s status (there are forms of exemption – esenzione in Italian – for low income and serious illnesses).
The Italian National Healthcare Service (SSN – Servizio Sanitario Nazionale) is the Public, tax-funded medical assistance, organized and regulated by the Ministry of Health and administered through regional authorities. To access the Italian National Healthcare Service you must hold a valid Tessera Sanitaria (Italian Health Insurance Card) or the equivalent from another EU country (the EHIC card – European Health Insurance Card).
Foreign citizens with regular stay permit are fully entitled to the same rights and treatment as any Italian citizen.
Public healthcare is provided through regional health units called ASL (Azienda Sanitaria Locale – Local Health Authority) and Public Hospitals. In Rome, for example, there are six Public Hospitals, and more than 50 ASL offices.
The ASL is an administrative organization, which manages a set of public clinics and medical services (e.g. vaccination centers, public walk-in clinics, labs for analyses and imaging, etc.).
Public medical assistance includes a network of primary care physicians and pediatricians.
You will be asked to choose your public Primary Care Physician (called medico di base, your personal doctor). Once registered with your public Primary Care Physician, you are entitled to free consultations, referrals and prescription refills with this doctor, within his or her office hours. Make sure to choose a doctor who has convenient office hours, especially if you have difficulty leaving work to see the doctor.
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 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.
When you get your Tessera Sanitaria (Italian Health Insurance Card) you are officially entitled to the same rights and duties regarding healthcare as Italian citizens. For example you can:
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 National Service (SSN – Servizio Sanitario Nazionale).
With the EHIC card, you have access to the same benefits of an Italian citizen holding the local Italian Health Insurance Card (Tessera Sanitaria) so everything you find in this article in relation to how to use the Tessera Sanitaria applies to you as well.
Consultations with your public Primary Care Physician (Medico di base) and with the pediatrician (Pediatra di libera scelta) are free. Hospital admission is free if you are admitted for a necessary procedure. If you want to have an elective procedure (for example a preventive check up), this would not be free.
Some specialist consultations, lab analyses, and diagnostic procedures are free, but only if prescribed by your public Primary Care Physician (medico di base).
You can book them with a so called “Red prescription” (in Italian “Ricetta Rossa” – also called impegnativa – it is the official document that shows you are doing a procedure within the Italian National Healthcare Service).
Also some medicines are free (usually the ones related to serious illness or life threatening conditions) while for others you can get a discounted fee if you have a red prescription from your public Primary Care Physician (medico di base).
As with all things free, there is a flip side of the coin. To avoid being disappointed, keep in mind that:
If you are registered with the Italian National Healthcare Service (SSN – Servizio Sanitario Nazionale), you have also selected your public Primary Care Physician (medico di base), the general practitioner who is in charge of your health. You can go visit this doctor within the official working hours he or she has declared. You can also call to request a house visit, if you cannot get out of bed.
On Saturdays, Sundays, and during the night (from 8pm to 8 am) every day, or if you are in a different city and cannot see your personal doctor, you can find primary care assistance at a Healthcare Assistance Continuity Center near you ( usually known as Servizio di continuità assistenziale in Italian) where you will be seen by an NHS doctor who can help you with prescriptions and refills, medical consultations and dressing of minor wounds. This may have a fee, depending on local and regional rules. This public centers are available also for phone consultations, though the staff may not speak English.
During the summer, in the areas with high tourist flow, a Doctor on Duty service for tourists is activated. For organizational reasons, this service requires the payment of the visit by all tourists. The fee can be different in every Region.
If you prefer a private alternative or to see an English speaking doctor, it would be better to book an appointment at a private medical center dedicated to English speaking patients, or to find a private walk-in clinic clearly offering services in English. In this case you would have to pay a fee, probably higher than the one you would pay for the Doctor on Duty service. The invoice given to you after the consultation can be used to claim for refund with your private medical insurance provider.
To see a Private doctor, regardless of your nationality, you can contact a private medical center to book an appointment, to learn about walk-in hours or to request a specialist. Some services are more prepared to assist English speaking patients, a good way to know is to check if the staff who answers the phone speaks English. Private doctor fees should be the same for Italian and foreign patients (if they are different beware of a possible scam!). Your travel insurance or medical insurance is likely to cover the cost of your consultation, especially if you get sick or injured during your time in Italy.
For specialist consultations, many Italians rely on private medical centers for increased comfort, closer doctor-patient relationship, more flexibility in scheduling options and faster access to medical assistance.
Consultations with a specialist prescribed by primary care physicians of the Italian National Healthcare Service (like your medico di base who is part of the Italian NHS or by other doctors you see within the NHS), can be arranged at either Public Healthcare Centres or at the ones that are private with NHS agreement (Privato Convenzionato). These services are subject to co-payment (called Ticket), which is non-refundable.
If you are looking for the least expensive option you can either go to the Emergency Room (if it is something very urgent) or you can book an appointment at a public hospital (if it is not urgent). If you go to the Emergency Room for a non-urgent need, you are likely to end up waiting a long time, paying the Ticket, and simply being referred for a consultation with a specialist, without seeing one. Moreover you would be increasing the workload of a fragile system, often on the verge of collapse. The co-pay for non-emergency cases is intended as a means to avoid patients overcrowding the ER, limiting access to those who really need emergency assistance.
If you really need to see the specialist soon, your family doctor can request an urgent appointment in the prescription (within 10 days or within 30 days), which will give you access to an earlier available slot saved for urgent needs.
Once you have the red prescription, you can book your appointment online (in some regions, for Lazio see here) or by calling the regional CUP (Centro Unico di Prenotazione Regionale – regional central booking office – 803333 for Lazio). You can also call directly a Hospital at their CUP phone number. You will need an Italian friend to help you book the appointment: there is no translation or English-speaking operator. Remember that you cannot choose your doctor, the earliest publicly available appointment will be assigned to you by the operator.
The process is similar to seeing a specialist. You can choose between:
Keep in mind that public clinics and hospitals do not send results over email, so if you do lab analyses you will need to go back in person to collect the results.
Emergency medical assistance in Italy is provided to everyone, without asking for upfront payment or insurance information. If you are in a medical emergency, you can take a taxi and walk-in to the closest Pronto Soccorso (Emergency Room).
For emergency assistance you can also call 118 (no country code needed if calling from Italy. If calling from outside, dial +39 118). The emergency medical assistance number 118 will ask questions about the patient’s conditions, address, phone number to reach you. If the patient needs urgent access to an ER, they will send an ambulance or a helicopter.
The service is provided at no charge, but of course only for serious medical conditions requiring emergency response. The ambulance will take you to an Emergency Room where you will be evaluated and treated as soon as possible.
Patients accessing the ER are not seen in order of arrival but based on the urgency of their need, assessed through a standard evaluation process called triage which assigns them a color code
Hospital assistance and admission, if required, is free of charge if you have the EHIC card or the Italian Health Insurance Card (Tessera Sanitaria).
If you don’t, the fees are still very reasonable, and if you keep the receipts you may be reimbursed by your private medical insurance provider.
If you want a private room and more comfort, you can request it at a charge. You can also be transferred to a Private Hospital of your choice by arranging admission. You will get the quotation in advance, so you can choose if you wish to be transferred.
The qualifications of doctors at public and private hospitals are the same, the difference would be in comfort, access to English Speaking staff in selected clinics, the possibility to choose your doctor, and in some cases a shorter waiting time for a surgery (for non life threatening orthopedic surgery, for example).
The answer is No.
Your Italian Health Insurance Card (Tessera Sanitaria) will work only with your Public Primary Care Physician, who is your go-to doctor, and the doctors at the public clinics called “servizio di continuità assistenziale” dedicated to patients who are not in their current city of residence (or with urgent needs that cannot wait for the doctor’s working hours). If you have the EHIC card and are not registered with any specific public Primary Care Physician, you can go to any Public Primary Care Doctor for medical assistance.
Your National Healthcare Service Primary Care Physician can give you a free prescription refill if you need it. As for the cost of medicines, in Italy they are rarely very expensive in general. With the red prescription given to you by a National Healthcare Service Doctor (if you have a Tessera Sanitaria) some medicines are free (usually the ones related to serious illness or life threatening conditions) while for others you can get a discounted fee.
The reciprocal agreement between your country of origin and Italy allows you to access Public Healthcare in Italy at no fee or at a lower fee, without registering to the NHS, under certain conditions:
The agreement covers medical care if admitted to a hospital and for outpatient treatment, but only at Public Hospitals, Public Primary Care Physicians and Public Outpatient Clinics.
Coverage may vary from country to country, check here if your country of origin has reciprocal healthcare agreement with Italy and what is covered.
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