Italy criticised once again over its healthcare system

Italy remains below the OECD average in terms of both per capita healthcare expenditure and healthcare expenditure as a proportion of GDP. In 2024, according to Mediobanca’s annual report, public healthcare expenditure in Italy amounted to €138.3 billion, equivalent to 6.3 per cent of GDP, trailing behind Spain (6.7 per cent), the United Kingdom (9.1 per cent), France (9.7 per cent) and Germany (10.6 per cent). “The resources from the National Recovery and Resilience Plan (PNRR),” the report notes, “have facilitated the reorganisation of healthcare provision, contributing to the development of local healthcare services and digitalisation, without significantly affecting the structural trend in expenditure.” And the situation does not appear set to improve. Estimates for the period 2026–2029 indicate, in fact, that national public healthcare expenditure will stabilise at 6.4 per cent of GDP, whilst the share of healthcare in primary current expenditure is expected to rise (15.7 per cent in 2027 compared with 15.4 per cent in 2025), confirming the growing burden on the public budget.

The Mediobanca study refers to 2024 as this is the most recent year for which financial statements are available for private sector operators in this field, whose role in Italy is constantly growing: indeed, their turnover is expected to rise by 3.7 per cent in 2025 compared with the previous year (€13.4 billion). Furthermore, almost 80 per cent of the total value of public expenditure originates from public facilities, whilst 20.8 per cent comes from those accredited by the National Health Service (the private operators for which accreditation accounts for the largest share of total revenue are ICS Maugeri (96 per cent) and San Raffaele Roma, owned by the Angelucci family (87.2 per cent)). Overall, according to Mediobanca, the Italian healthcare system continues to be governed by a model geared towards containing expenditure, based on spending caps and the centralisation of procurement, whilst the Attorney General of the Court of Auditors has highlighted the need for a more selective allocation of resources.