The Italy continues to spend too little on the health of its citizensIn 2024, public health spending stood at 6,3% of GDP, well abovefar from the OECD average (7,1%) and the European one (6,9%). In per capita terms, we are talking about 3.835 dollars per inhabitant, against the 4.625 of the OECD average and the 4.689 of the EU countries. A gap of 729 euros per person, which multiplied by the Italian population becomes a 43 billion euro hole. Numbers that place Italy 14th out of 27 in Europe and in last place among the G7 countries.
According to Gimbe Foundation, which reworked the OECD Health Statistics data updated to 30 July 2025, the picture leaves no room for interpretation: the defunding is no longer a passing emergency, but a political choice with distant roots.
The price of underfunding: growing sacrifices and inequalities
The consequences are there for all to see. Waiting lists out of control, emergency room at the limit, shortage of general practitioners and strong territorial imbalances between North and South. private healthcare often becomes the only shortcut, but not for everyone: in 2024, 5,8 million Italians (almost one in ten) gave up on treatment for economic reasons.
“Public underfunding of the Italian healthcare system is now a structural issue – denounces the president of Gimbe, Nino Cartabellotta –. The Regions are increasingly struggling to guarantee essential levels of assistance, and citizens are paying the price with poor services and additional costs."
Italy "first among poor countries"
Il the comparison with Europe is merciless. Tthirteen EU countries invest more than ItalyIt ranges from a few dollars more than Spain, to Germany which surpasses Rome by over 4.200 dollars per capita, with public spending equal to 10,6% of GDP. But not only that. According to Gimbe, now Italy ranks "first among poor countries", because even the Czech Republic, Slovenia and Spain allocate more resources to healthcare.
This decline isn't new. Until 2011, Italian spending was in line with the European average, but cuts in subsequent years have deepened the gap. In 2019, the gap was $430 per capita, widening during the pandemic when other countries increased investment. Italy, however, did not. And so the gap has solidified.
The "report cards" on the Essential Levels of Assistance (LEA): only 11 Regions passed
Underfunding does not only affect macroeconomic numbers, but undermines the Regions' ability to guarantee essential levels of assistance (Lea), or the services that every citizen has the right to receive free of charge or with a ticket.
Every year the Ministry of Health assigns real "report cards" to regional administrations. Until 2019 the system was based on the so-called “Lea Grill”; since 2020 it has been replaced by the New Guarantee System, with 22 indicators divided into three areas: prevention, district and hospital care. To pass the exam, a Region must reach at least 60 points in each of the three areas: those who fail are classified as defaulters and are subject to repayment plans, up to and including possible administration.
The 2020 monitoring, conducted for information purposes only, given the pandemic emergency, certified that only 11 Regions were compliant: Emilia-Romagna, Friuli Venezia Giulia, Lazio, Lombardy, Marche, Piedmont, Province of Trento, Puglia, Tuscany, Umbria and Veneto. ten more have failed in at least one of the three areas, with Calabria recording deficiencies everywhere.
For Gimbe, these differences reflect not only the different resilience of regional systems during the pandemic, but also a historical fracture between North and South, accentuated by the chronic scarcity of resources.
Gimbe: "We need a political pact to refinance healthcare."
On the eve of the 2026 Budget Law, the Foundation asks to to escape from the ritualistic theatre of the "downward maneuver"", where the Minister of Health is extorting a few more billion from the Ministry of Economy and Finance. "The debate over defunding cannot be reduced to this," warns Cartabellotta. "We need a cross-party commitment that transcends governments and progressively refinances public healthcare, coupled with structural reforms. Healthcare is not only a fundamental right, it is also an investment in the country's economic growth and social stability."
Without adequate resources, the national health system risks losing its universalistic mission.
