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On 23 December 1978, Law No 833, passed by 85% of Parliament’s votes established the Italian National Health Service, based on universality of healthcare, solidarity of financing through general taxation and equitable access to services.

Since then, the history of public health has been closely linked with the Italian Constitution, with the country’s civil and democratic growth and its economic and social development. Subsequent milestones included the establishment of the system of local health authorities to promote efficient and effective management and the setting of the core benefit package (Essential Levels of Care - LEA) to ensure uniformity of service delivery across the country.

The Italian National Health Service rests on core values and major strengths, which have been acknowledged over the years by major international bodies such as the WHO and the OECD.

Values and strengths of the Italian NHS (SSN)

High-quality healthcare for all citizens

The Italian Health Service makes the right to health accessible to all citizens, without discrimination based on income, gender or age. Our NHS provides high-quality healthcare to all citizens for hospital care, emergency care and primary care provided by general practitioners and paediatricians. In addition, the NHS covers a wide range of pharmaceuticals and all the hospital and diagnostic services essential for health.

Universality, equity, solidarity

These are the three guiding principles of our national health service, to achieve uniform levels of care throughout the territory, equitable access to services for all citizens and fiscal solidarity as the fundamental way of financing the health system. This means that all services included in the core benefit package (LEA) must be equally accessible in all Italian regions.

This is an extraordinary societal achievement and a key indicator of a country’s social and democratic development. In Italy we perhaps take this as a given, but around the world only a minority of countries deliver this type of healthcare to all citizens, without any discrimination.

Leader in Europe in terms of free medicines

We have the largest number of prescription drugs dispensed by the National Health Service in Europe: in Italy, all the drugs for the treatment of serious and chronic diseases, including last-generation innovative medicines are offered free of charge. Total and public per capita spending on medicines in Italy is in line with the European average. 69% of national pharmaceutical expenditure is borne by the National Health Service: total pharmaceutical spending reached € 28.1 billion in 2017 (€ 464 per capita), of which € 19.5 billion borne by the National Health Service (€ 322 per capita) and € 8.6 billion (€ 142 per capita) borne by patients (Source: Annual Report of the Pharmaceuticals Observatory Year 2017 - Cergas Bocconi Centre).

Excellence in organ transplants

Italy has one of the best national organ transplant networks in Europe in terms of quality of procedures, donor database management and organ availability.

Free paediatrician for all children

In Europe, only Italy allows families to choose their paediatrician at no cost to them for all children aged 0 to 14 years.

At the forefront of high-tech diagnostics

Italy is one of the countries with the highest number of CT scanning and MRI equipment per million inhabitants in Europe.

Quality and safety standards in healthcare

The delivery to all citizens of health services meeting specific quality and safety standards is ensured by the development of national quality criteria and standards that act as the blueprint for regional accreditation systems, so that health facilities are equipped with resources, skills and organisation appropriate to the care they deliver. Thus, accreditation is the essential prerequisite for a health facility to become a provider on behalf of the Italian NHS, ensuring equality of conditions between public and contracted private health providers, protecting the citizen’s right of choice of health facility and ensuring equal tariffs and the equitable remuneration of providers.

The system has evolved over time, as the rules have been reviewed to make the regional accreditation systems more uniform and responsive to the growing demand for an objective methodology to evaluate the quality of care. Eight criteria have been identified, which must be included in the reference legislation of each Region and evaluated in a uniform manner throughout the national territory. These criteria, which cover various areas are: Health facility management systems, Benefits and services, Structural aspects, Personnel skills, Communication, Clinical appropriateness and patient safety, Improvement and innovation processes and Humanisation.

Prevention - to stay healthy and avoid diseases

Italy is at the forefront in disease prevention programmes, managed by more than 150 public prevention departments, with over 10,000 operators.

We were the first European country to make the new HPV vaccination against cervical cancer available to 12-year-old girls free of charge. While from 2013 to 2016 vaccination coverage showed a decreasing trend, falling below the 95% threshold recommended by the WHO, in 2017 coverage improved significantly in all age groups, thanks to the extraordinary measures put in place during the year, in particular approval of the Vaccination Decree and the accompanying public communication campaigns.

We have achieved major results in the fight against passive smoking with a significant decrease in the respiratory and cardiovascular diseases associated with smoking.

We have more than 5,000 public operators dedicated to occupational health and safety.

For many years now, we have been conducting the health promotion programme Gaining Health against alcohol, smoking, poor nutrition and physical inactivity in coordination with many other ministries and institutions, taking an integrated approach to the promotion of healthy lifestyles and habits in all areas, from school to work.

We also have an efficient veterinary network, with 10,000 operators who guarantee animal health and food safety.


Data di pubblicazione: 4 aprile 2014, ultimo aggiornamento 28 ottobre 2019

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