Italy: #29 in the 2024 World Index of Healthcare Innovation

Introduction

In the 2024 World Index of Healthcare Innovation, Italy moved to 29th overall, improving one spot from 2022. Italy struggled in all four assessed dimensions, placing 25th in Quality, 31st in Choice, 25th in Science and Technology, and 26th in Fiscal Sustainability. Although healthcare costs in Italy are relatively low compared to other European countries, the system offers limited options regarding new therapies and choosing primary care providers. For example, once Italian citizens choose a primary care provider, they are unable to switch doctors for one year.

Background

Dating back to 325 C.E., Italy’s healthcare system began after the First Council of Nicæa, with the Roman Empire establishing a hospital in every cathedral town. The contemporary structure, known as the Servizio Sanitario Nazionale (SSN), was instituted in 1978, marking the beginning of Italy’s unified, publicly funded healthcare system. Governed through a tiered system, the SSN is divided into 19 regions and two autonomous provinces, each responsible for the health services in their respective areas, reflecting a high degree of decentralized management.

Financially, Italy’s healthcare model is largely supported by public funds, with around 76 percent of total healthcare expenditures covered by the state as of 2022. These expenses represented 9.7 percent of Italy’s GDP in the same year, showing a minor uptick from previous figures. Public funding is derived from general and regional revenues, including corporate and value-added taxes. Private health insurance, while not predominant, still plays a role, covering 10 percent of the population—approximately six million Italians—and focuses mainly on elective procedures not included in the public coverage.

Italy’s hospital network is predominantly public, with 82 percent of all hospital beds under public management. The rest are managed by private entities. The management of public hospitals varies, with some directly managed by local health units and others operating as semi-independent public enterprises. Physicians employed in public hospitals are salaried and face restrictions on private practice, highlighting the system’s focus on public healthcare provision over private interests.

Key national agencies such as the National Committee for Medical Devices and the National Pharmaceutical Agency are integral to the cost management within the healthcare system. These agencies handle tasks ranging from cost-benefit analysis for medical devices to setting national benchmarks for drug pricing and reimbursement rates. Payment rates for hospital and specialist outpatient care, while primarily set regionally, are influenced by these national benchmarks, ensuring a balanced approach to cost control and quality healthcare provision across the country.

The SSN of Italy is a balance between centralized policymaking and regional administrative autonomy, allowing for adaptable healthcare delivery that meets diverse local needs while adhering to overarching national standards for quality and cost-efficiency.

Dimension Performance

Quality

Italy was ranked 25th in Quality, with its performance hindered by subpar pandemic preparedness and response (28th) and patient-centered care (23rd). The severity of the COVID-19 pandemic in Italy was largely attributed to outdated hospital infrastructure and a predominantly older patient demographic, which is a result of the notably long lifespan of Italian citizens. Moreover, Italy’s infrastructure was below average, ranking 21st. On a positive note, Italy performed well in measures of preventable disease, securing one of the best scores in the Index (5th).

Choice

Italy ranked 31st in Choice. Italy’s single-payer system is fairly affordable, ranking 16th in the Index. However, the same system also restricts access to new medical treatments (23rd), and severely restricts choice of healthcare services (31st). In fact, residents cannot select a primary care provider outside their home municipality, and once selected, cannot change providers for one year. Residents also cannot select a specialist unless they pay significantly more for the privilege.

Science and Technology

Italy’s performance in Science and Technology was well below average, ranking 25th overall. Specifically, its integration of health IT was notably weak, securing the 31st position in health digitization. Additionally, Italy ranked 16th in medical advances and 22nd in scientific discoveries, leaving a lot of room for improvement in these areas.

Fiscal Sustainability

Italy’s fiscal sustainability is ranked 26th. The fiscal health of its healthcare system remains uncertain. Despite ranking 9th in the growth of health spending, as the share of healthcare in GDP has significantly declined over the past decade, Italy’s national solvency stands at 29th. Similar to Greece and Spain, the lingering economic effects of the global recession and the COVID-19 pandemic continue to hamper the Italian economy. Additionally, Italy is ranked 20th in public healthcare spending.