Table Of ContentState of Health in the EU
Italy IT
Country Health Profile 2019
The Country Health Profile series Contents
The State of Health in the EU’s Country Health Profiles 1. HIGHLIGHTS 3
provide a concise and policy-relevant overview of 2. HEALTH IN ITALY 4
health and health systems in the EU/European Economic
3. RISK FACTORS 7
Area. They emphasise the particular characteristics and
4. THE HEALTH SYSTEM 8
challenges in each country against a backdrop of cross-
country comparisons. The aim is to support policymakers 5. ASSESSMENT OF THE HEALTH SYSTEM 11
and influencers with a means for mutual learning and 5.1. Effectiveness 11
voluntary exchange.
5.2. Accessibility 15
The profiles are the joint work of the OECD and the 5.3. Resilience 18
European Observatory on Health Systems and Policies, 6. KEY FINDINGS 22
in cooperation with the European Commission. The team
is grateful for the valuable comments and suggestions
provided by the Health Systems and Policy Monitor
network, the OECD Health Committee and the EU Expert
Group on Health Information.
Data and information sources The calculated EU averages are weighted averages of
the 28 Member States unless otherwise noted. These EU
The data and information in the Country Health Profiles averages do not include Iceland and Norway.
are based mainly on national official statistics provided
to Eurostat and the OECD, which were validated to This profile was completed in August 2019, based on
ensure the highest standards of data comparability. data available in July 2019.
The sources and methods underlying these data are
To download the Excel spreadsheet matching all the
available in the Eurostat Database and the OECD health
tables and graphs in this profile, just type the following
database. Some additional data also come from the
URL into your Internet browser: http://www.oecd.org/
Institute for Health Metrics and Evaluation (IHME), the
health/Country-Health-Profiles-2019-Italy.xls
European Centre for Disease Prevention and Control
(ECDC), the Health Behaviour in School-Aged Children
(HBSC) surveys and the World Health Organization
(WHO), as well as other national sources.
Demographic and socioeconomic context in Italy, 2017
Demographic factors Italy EU
Population size (mid-year estimates) 60 537 000 511 876 000
Share of population over age 65 (%) 22.3 19.4
Fertility rate¹ 1.3 1.6
Socioeconomic factors
GDP per capita (EUR PPP²) 28 900 30 000
Relative poverty rate³ (%) 20.3 16.9
Unemployment rate (%) 11.2 7.6
1. Number of children born per woman aged 15-49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the
purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 60 %
of median equivalised disposable income.
Source: Eurostat Database.
Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of
the OECD or of its member countries, or of the European Observatory on Health Systems and Policies or any of its Partners. The views expressed herein
can in no way be taken to reflect the official opinion of the European Union.
This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation
of international frontiers and boundaries and to the name of any territory, city or area.
Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/
© OECD and World Health Organization (acting as the host organisation for, and secretariat of, the European Observatory on Health Systems and
Policies) 2019
2 State of Health in the EU · Italy · Country Health Profile 2019
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1 Highlights L
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Italy enjoys the second highest life expectancy in Europe, although sizeable inequalities persist across regions and
by gender and socioeconomic status. The Italian health care system is generally efficient and performs well in
providing good access to high-quality care at a relatively low cost, although there are significant variations across
regions. The main challenges facing the health system relate to improving coordination of care for the growing
share of the population living with chronic diseases and reducing disparities in access to care.
IT EU Health status
85 Life expectancy at birth in Italy reached 83.1 years in 2017, the second highest
83.1
in the EU after Spain. Since 2000, the gender gap in life expectancy has
80.9
79.9 narrowed, but on average Italian men still live four years less than women.
80
77.3 Important disparities also exist by socioeconomic status and across regions:
the least educated Italian men on average live 4.5 years less than the most
75 2000 2017 educated, and people in the most affluent regions in the north live over three
Life expectancy at birth, years years more than those living in the least affluent regions in the south.
Country
Ris%k0 1fac%t0o1ErUs
IT EU
Smoking rates in Italy have decreased since 2000, but one in five adults still
Smoking 20% smoked daily in 2017, slightly more than the EU average (19 %). Obesity
among adults increased from 9 % in 2003 to 11 % in 2017 but remains
Binge drinking 7% belowECUo tuhnter yEU average (15 %). Excess weight problems among children and
adolescents are also an important public health issue, with about one-fifth
Obesity 11%
of 15-year-olds being overweight or obese in 2013-14, a share close to the
% of adults EU average. On a more positive note, the proportion of adults who report
episodic heavy drinking is much lower than in most EU countries.
Health system
IT EU
EUR 3 000 Health spending per capita in Italy was EUR 2 483 in 2017, about 15 %
Smoking 17 below the EU average of EUR 2 884. Health spending has started to
EUR 2 000
increase again in recent years, but at a slower rate than in most EU
EUBiRn g1 e0 d0r0inking 22 countries. As a share of the economy, health spending accounted for 8.8 %
2005 2011 2017 of GDP in 2017, one percentage point below the EU average of 9.8 %. Nearly
PeOr cbaepsiittay spending2 1(EUR PPP) three-quarters of health spending is publicly funded, with the rest paid
mainly through out-of-pocket payments.
Effectiveness Accessibility Resilience
Italy’s health system is relatively Unmet needs for medical care in As in many other
effective at avoiding premature Italy are generally low, although Member States,
deaths, with one of the lowest low-income groups and residents population ageing
rates of preventable and treatable in some regions experience will exert pressure on
causes of mortality in the EU. greater barriers to accessing some health and long-term
Country
serviEcUes. care systems in the years ahead,
IT EU
requiring increased efficiency
Preventable 110 High income All Low income through further transformation of
mortality service delivery models towards
157 IT
Treatable 67 EU the provision of chronic care
mortality outside hospitals.
93
0% 3% 6%
Age-standardised mortality rate
per 100 000 population, 2016 % reporting unmet medical needs, 2017
State of Health in the EU · Italy · Country Health Profile 2019 3
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L 2 Health in Italy
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Life expectancy at birth in Italy is of Italians increased by 3.2 years, a slightly slower
the second highest in the EU gain than in the EU as a whole (3.6 years).
At 83.1 years in 2017, Italy continues to enjoy the The gender gap in life expectancy is smaller than the
second highest life expectancy at birth in the EU after EU average. While Italian women still live more than
Spain and more than two years above the EU average four years longer than men, this gap has narrowed
(Figure 1). Between 2000 and 2017, the life expectancy by 1.5 years as men’s life expectancy increased more
rapidly than that of women between 2000 and 2017.
Figure 1. Italians enjoy the second highest life expectancy in the EU
Years 2017 2000
90 –
Gender gap:
4 Italy: 4.4 years
85 – 83. 83.1 82.7 82.7 82.6 82.5 82.4 82.2 82.2 82.1 81.8 81.7 81.7 81.6 81.6 81.4 81.3 81.2 81.1 81.1 80.9 EU: 5.2 years
9.1 4
80 – 7 78. 78 77.8 7.3
7 8
76 75. 75.3 74.9 74.8
75 –
70 –
65 –
Spain ItalyFranceNorwaIycelanSdweden MaltaCyprusIrLeluaxnedmbNoeturhgerlandsAustriaFinlanBdelgiuPmortuganlitGreed ecKiengdoSlmoveniGaermanDyenmark EUCzechiaEstoniaCroatiaPolanSldovakiHaungaLrityhuaniRaomaniaLatviBaulgaria
U
Source: Eurostat Database.
Inequalities in life expectancy are less Figure 2. The education gap in life expectancy is
4.5 years for men and about 3 years for women
pronounced than in other EU countries
Although less severe than in most other EU countries,
inequalities in life expectancy by socioeconomic
status remain non-negligible in Italy. As shown
in Figure 2, 30-year-old men with lower levels of 57.6
education live on average 4.5 years less than those 54.7 years 54.1
years years
with the highest level of education. This education 49.6
years
gap in longevity is smaller among women, at about
three years. These gaps can be explained at least
partly by differences in exposure to various risk Lower Higher Lower Higher
educated educated educated educated
factors and unhealthy lifestyles, including higher
women women men men
smoking rates and poorer nutritional habits among
men and women with lower levels of education. Education gap in life expectancy at age 30:
Italy: 2.9 years Italy: 4.5 years
Regional inequalities in life expectancy also exist but EU21: 4.1 years EU21: 7.6 years
are less pronounced than those by education level. In
2017, the region with the highest life expectancy at Note: Data refer to life expectancy at age 30. High education is defined
as people who have completed tertiary education (ISCED 5-8), whereas
birth was the northern region of Trentino-Alto-Adige,
low education is defined as people who have not completed secondary
where citizens could expect to live over three years education (ISCED 0-2).
longer than in the southern region of Campania, Source: Eurostat Database (data refer to 2016).
which had the lowest.
4 State of Health in the EU · Italy · Country Health Profile 2019
Cardiovascular diseases remain the colorectal cancer are the most frequent causes of Y
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main cause of death in Italy death from cancer, but mortality rates have also A
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decreased by about 15 % since 2000. I
The increase in life expectancy since 2000 has mainly
At the same time, mortality rates from Alzheimer’s
been driven by substantial reductions in mortality
disease have increased significantly in Italy, although
rates from ischaemic heart disease and stroke,
this rise is due largely to improvements in diagnosis
although they remained the two leading causes of
and changes in death registration practices.
death in Italy in 2016 (Figure 3). Lung cancer and
Figure 3. Ischaemic heart disease, stroke and lung cancer are still the leading causes of death
% change 2000-16 (or nearest year)
100
Alzheimer’s disease
50
Pancreatic cancer
0
10 20 40 50 60 70 80 100
Pneumonia Lung cancer
Breast cancer
-50
Chronic obstructive pulmonary disease
Colorectal cancer
Diabetes
Stroke Ischaemic heart disease
-100
Age-standardised mortality rate per 100 000 population, 2016
Note: The size of the bubbles is proportional to the mortality rates in 2016. The increase in mortality rates from Alzheimer’s disease is largely due to changes
in diagnostic and death registration practices.
Source: Eurostat Database.
Many years of life after age 65 are lived with Slightly less than half of Italians aged 65 and over
some chronic diseases and disabilities reported having at least one chronic disease in 2017,
which is lower than the EU average. Most people are
Sustained gains in life expectancy combined with able to continue to live independently in old age, but
low fertility rates over the last two decades have one in six Italians aged 65 and over reported in 2017
contributed to a steady rise in the share of the some limitations in basic activities of daily living,
population aged 65 and over. In 2017, more than one such as dressing and eating, which may require
in five Italians was aged 65 years and over, up from long-term care assistance. About four in ten people
only one in eight in 1980; this share is projected to aged 65 years and more reported some depression
increase to around one in three people by 2050. symptoms, a higher proportion than the EU average.
In 2017, life expectancy at age 65 reached nearly
21 years, one year above the EU average (Figure 4).
However, as in other countries, Italians spend slightly
more than half of these additional years of life after
65 with some health issues and disabilities. The
gender gap in life expectancy at age 65 is about three
years in favour of women, but there is no gender gap
in the number of healthy life years because Italian
women live a greater proportion of their lives in old
age with some health issues and disabilities.
State of Health in the EU · Italy · Country Health Profile 2019 5
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Life expectancy at age 65
Italy EU
9.6 20.9 19.9
years 11.3 10 years 9.9
Years without Years with
disability disability
% of people aged 65+ reporting chronic diseases1 % of people aged 65+ reporting limitations
in activities of daily living (ADL)2
Italy EU25 Italy EU25
17% 20% 18% 18%
46%
51%
32%
34%
82% 82%
No chronic One chronic At least two No limitation At least one
disease disease chronic diseases in ADL limitation in ADL
% of people aged 65+ reporting depression symptoms3
Italy EU11
41% 29 %
Note: 1. Chronic diseases include heart attack, stroke, diabetes, Parkinson disease, Alzheimer’s disease and rheumatoid arthritis or osteoarthritis. 2. Basic
activities of daily living include dressing, walking across a room, bathing or showering, eating, getting in or out of bed and using the toilet. 3. People are
considered to have depression symptoms if they report more than three depression symptoms (out of 12 possible variables).
Sources: Eurostat Database for life expectancy and healthy life years (data refer to 2017); SHARE survey for other indicators (data refer to 2017).
6 State of Health in the EU · Italy · Country Health Profile 2019
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3 Risk factors L
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Behavioural risk factors account for About 16 % (98 000) of deaths in 2017 were related
one-third of all deaths in Italy to dietary risks (including low fruit and vegetable
intake and high sugar and salt consumption). Tobacco
Estimates suggest that about one-third of all deaths consumption (including direct and second-hand
in Italy in 2017 could be attributed to behavioural smoking) was responsible for an estimated 14 % (over
risk factors, including dietary risks, tobacco smoking, 90 000) of all deaths. About 4 % (26 000) of deaths
alcohol consumption and low physical activity could be attributed to alcohol consumption, and 3 %
(Figure 5; IHME, 2018). This is much lower than the EU (18 000) to low physical activity. All these shares are
average. below the EU average except for low physical activity.
Figure 5. About one-third of all deaths can be attributed to modifiable risk factors
Dietary risks Tobacco Alcohol
Italy: 16% Italy: 14% Italy: 4%
EU: 18% EU: 17% EU: 6%
Low physical activity
Italy: 3%
EU: 3%
Note: The overall number of deaths related to these risk factors (210 000) is lower than the sum of each one taken individually (231 000), because the same
death can be attributed to more than one risk factor. Dietary risks include 14 components such as low fruit and vegetable consumption and high sugar-
sweetened beverages and salt consumption.
Source: IHME (2018), Global Health Data Exchange (estimates refer to 2017).
Smoking remains an important Overweight and obesity rates are high
public health issue among children and adolescents
Tobacco consumption remains a major public health Nearly one in five 15-year-olds in Italy (18 %) was
issue in Italy, particularly among men, with one in overweight or obese in 2013-2014, according to the
four reporting smoking daily in 2017, compared with Europe-wide HBSC survey. Another more recent
15 % of women. While this proportion has decreased national survey focusing on primary school children
slightly over the past decade, it remains higher than reported even higher rates, showing that nearly one
in most EU countries. in three children (31 %) aged 8-9 years was either
overweight or obese in 2016, but this rate was down
Smoking rates among teenagers in Italy remain
slightly from 35 % in 2008 (Spinelli et al., 2017).
very high. In 2015, more than one-third of 15- and
16-year-old boys and girls reported they had smoked High rates of overweight and obesity among children
at least occasionally in the past month, the highest are at least partly linked to low physical activity.
rate in the EU (Figure 6). Smoking rates among Italian Only 5 % of 15-year-old girls and 11 % of 15-year-old
adolescents have not fallen between 1995 and 2015, boys reported doing at least moderate daily physical
while they have dropped in most other EU countries. exercise in 2013-14, the lowest rate across EU
countries. The level of physical activity among Italian
adults is also among the lowest in the EU.
Obesity among adults has increased slightly over the
past 15 years, up from 9 % in 2003 to 11% in 2017
according to a national survey, but it remains lower
than in most EU countries.
State of Health in the EU · Italy · Country Health Profile 2019 7
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Smoking (children)
Vegetable consumption (adults) 6 Smoking (adults)
Fruit consumption (adults) Binge drinking (children)
Physical activity (adults) Binge drinking (adults)
Physical activity (children) Overweight and obesity (children)
Obesity (adults)
Note: The closer the dot is to the centre, the better the country performs compared to other EU countries. No country is in the white ‘target area’ as there is
room for progress in all countries in all areas.
Sources: OECD calculations based on ESPAD survey 20S15e laenctd dHoBtSsC +su rEvfefye 2c0t 1>3- 1T4r afonrs fcohrilmdr esnc ainled i1c3a0t%ors; and EU-SILC 2017 and EHIS 2014 and OECD Health
Statistics 2019 for adults indicators.
A greater proportion of Italian adults report the lowest in the EU. The proportion of adults who
consuming at least one portion of fruit and vegetable report heavy episodic alcohol consumption (“binge
per day than in most EU countries; nevertheless, drinking”1) is also much lower than in nearly all other
15 % reported in 2017 that they did not eat at least EU countries.
one fruit each day and 20 % that they did not eat any
However, binge drinking among adolescents is quite
vegetables.
widespread. In 2015, around one-third of 15-16-
Alcohol consumption among adults is low, but year-old boys and girls reported at least one episode
a third of adolescents engage in binge drinking of heavy alcohol drinking during the past month, a
proportion close to the EU average.
Alcohol consumption among adults in Italy has
decreased by about 20 % since 2000 and is now among
4 The health system
Italy has a highly decentralised health organisation and delivery of health services through
system providing universal coverage local health units and public and accredited private
hospitals. The health service covers all citizens and
The Italian health system is characterised by a legal foreign residents. Coverage is automatic and
decentralised, regionally based national health service universal, and care is generally free for hospital and
(NHS). The central government channels general tax medical services. Irregular immigrants have been
revenues for publicly financed health care, defines entitled to access urgent and essential services since
the benefit package (known as the livelli essenziali 1998.
di assistenza, ‘essential levels of care’) and exercises
overall stewardship. Each region is responsible for the
1: Binge drinking is defined as consuming six or more alcoholic drinks on a single occasion for adults, and five or more alcoholic drinks for adolescents.
8 State of Health in the EU · Italy · Country Health Profile 2019
Health spending in Italy is lower Public spending accounted for 74 % of health Y
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than the EU average expenditure in 2017 (or 6.5 % of GDP). Although the A
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basic benefit package covers a wide range of services, I
In 2017, Italy spent 8.8 % of its GDP on health care, direct out-of-pocket (OOP) payments by households
a lower share than the EU average of 9.8 %. In per are relatively high (24 %), making up most of the
capita terms, health expenditure amounted to EUR remaining expenses. Private health insurance plays
2 483 (adjusted for differences in purchasing power), a minor role, covering only about 2 % of total health
more than 10 % below the EU average of EUR 2 884 expenditure.
(Figure 7). Following the economic crisis in 2009,
health spending per capita fell until 2013, after which
it started to increase again at least moderately.
Figure 7. Italy spends less on health care than most other western European countries
Government & compulsory insurance Voluntary schemes & household out-of-pocket payments Share of GDP
EUR PPP per capita % of GDP
5 000 12.5
4 000 10.0
3 000 7.5
2 000 5.0
1 000 2.5
0 0.0
NorwaGyermanyAustriSawNeedtehnerlanDdsenmarkFLruaxnecembourBgelgiumIrelanIdcelaUnndiFitenlda nKidngdom EU Malta ItalySpainCzechiSlaoveniPaortugalCyprusGreecSleovakLiitahuaniaEstoniaPolanHdungarByulgariaCroatiaLatviRaomania
Source: OECD Health Statistics 2019 (data refer to 2017).
The regions’ health care deficits have Box 1. The benefit package was expanded in 2017,
buBt osexv 1e. rTahl er ebgeionnefsi td op ancokta hgaev wea tsh eex cpaapnadcietdy to
been reduced substantially
deliinv e20r 1n7e, wbu ste srevviceersal regions do not have the
capacity to deliver new services
Italy’s NHS is mainly funded through general taxation,
complemented by revenues from regional business In January 2017, the Italian government approved
In January 2017, the Italian government approved
and individual income taxes and co-payments a moderate expansion of the benefit package to
a moderate expansion of the benefit package to
include treatment for a list of rare and chronic
paid directly by patients. Different fiscal capacities
include treatment for a list of rare and chronic
diseases, new diagnostic services, new vaccines,
and health system efficiency levels across regions
neodnisaetaasel ss,c nreeewn diniagg annodst aics sseisrtviivcees d, nevewice vsa. cTchinee ns,e w
raise concerns about the ability of poorer or lower-
pacnkeaogneat aalls soc rienecnluindge adn ad laosnsgis-toivvee drdeuveic eusp. dThaete n oefw
performing regions to provide access to high-quality thep atackriafgfes palasiod i nfoclru ddiefdfe ar elonntg s-eorvveircdeuse. Huopwdaetvee or,f the
health care services without increasing regional taxes lactkh oe ft anraiftfiso npaaild g fuoird deilfinfeerse natn sde rfvinicaensc. iHaol wcoenvsetr,r athinet s
or running deficits (Box 1). Nevertheless, through have resulted in different levels of implementation
lack of national guidelines and financial constraints
very tight expenditure controls, most regions have across regions. The national committee responsible
have resulted in different levels of implementation
for monitoring the provision of the benefit
managed to keep their health budgets balanced in
across regions. The national committee responsible
package reported that in 2017 five regions did not
recent years. In 2017, only seven of the 20 regions
comfopr lmy owniittho rtinhge tnhaet ipornovails oiobnj eocft tivhees b aenndef tita rgets
were under nationally supervised recovery plans
(Capmacpkaangiea ,r eVpaollrete dd’ Athoastt ain, S2a0r1d7 ifniivae, rCeagliaobnrsi ad iadn ndo tt he
(Abruzzo, Apulia, Calabria, Campania, Lazio, Molise
Auctoomnopmlyo wuist hP rtohve innactei oonfa Bl oolbzjaenctoiv).e s and targets
and Sicily) – fewer than in 2007.
(Campania, Valle d’Aosta, Sardinia, Calabria and the
Autonomous Province of Bolzano).
State of Health in the EU · Italy · Country Health Profile 2019 9
Y Regions can also choose to offer services beyond its own co-payment levels for pharmaceuticals,
L
A the benefit package list, but must finance these with various exemptions for some population
T
I themselves. Significant inter-regional mobility of groups, meaning that co-payment levels are not
patients is one indicator of inequalities in health homogeneous across the country. There are no annual
service delivery across the country. The percentage of ceilings on co-payments, so these have the greatest
patients treated in a different region than their home impact for heavy users of health services who are not
region increased from 7 % in 2001 to about 8.5 % in eligible for exemptions.
2016. The proportion of patients in the south choosing
The number of doctors is higher than the EU
to be treated in another region is almost twice as high
as in the north. average, while the number of nurses is lower
User fees are common across Italy, but rates While the total number of doctors per population in
and exemptions vary between regions Italy is higher than the EU average (4.0 compared with
3.6 per 1 000 population in 2017), the number working
Historically, OOP spending has made up a little more in public hospitals and as general practitioners
than one-fifth of all health spending. However, over (GPs) is declining, and more than half of doctors are
the last decade, the share has gradually increased, aged over 55, raising serious concerns about future
reflecting rising cost-sharing requirements for shortages.
many health services and pharmaceuticals in
Italy employs fewer nurses than nearly all western
several regions (see Section 5.2). Co-payments are
European countries (with the exception of Spain), and
required for diagnostic procedures, pharmaceuticals,
the number is substantially lower than the EU average
specialist visits in outpatient settings and
(5.8 nurses per 1 000 population compared with 8.5 in
unjustified (non-urgent) interventions in hospital
the EU; Figure 8).
emergency departments. Each region establishes
Figure 8. Compared to the EU average, Italy has a high number of doctors but fewer nurses
Practicing nurses per 1 000 population
20
Doctors Low Doctors High
Nurses High Nurses High
18 NO
16
FI IS
14
IE DE
12 LU
BE
NL SE
10 SI DK
FR
EU EU average: 8.5
8 UK HR MT LT
HU
RO EE CZ ES PT AT
6 IT
PL SK
LV CY BG
4
EL
2
Doctors Low Doctors High
Nurses Low EU average: 3.6 Nurses Low
0
2 2.5 3 3.5 4 4.5 5 5.5 6 6.5
Practicing doctors per 1 000 population
Note: In Portugal and Greece, data refer to all doctors licensed to practise, resulting in a large overestimation of the number of practising doctors (e.g. of
around 30 % in Portugal). In Austria and Greece, the number of nurses is underestimated as it only includes those working in hospitals.
Source: Eurostat Database (data refer to 2017 or the nearest year).
10 State of Health in the EU · Italy · Country Health Profile 2019
