In Italy, the right to healthcare is not equal for everyone: “Sussidiarity and… Health” Report presented at a meeting promoted by MP Gadda

In Italy, income also makes a difference when it comes to accessing healthcare: more than one in ten people (12%) among those with the lowest incomes forego a specialist consultation, compared with 8% of those in the highest income brackets. This gap shows that access to healthcare is not equal for everyone: the issue lies less in the national average level of unmet healthcare needs than in the variation hidden behind this aggregate figure across social groups and geographical areas. Even in Lombardy, the region that attracts more patients from other parts of Italy than any other, the rate of people foregoing healthcare (5.3%) places the region 7th nationally. The figure rises to 9.5% when it comes to foregoing specialist consultations.

This emerged today during the meeting “Universalism and Sustainability of the National Health Service”, held in Varese in the Aula Magna of the University of Insubria, on the occasion of the presentation of the “Sussidiarity and… Health” Report by the Foundation for Subsidiarity.

The meeting was attended by Minister of Economy and Finance Giancarlo Giorgetti and Maria Chiara Gadda, Member of Parliament and member of the Parliamentary Intergroup for Subsidiarity. Also taking part were Giorgio Vittadini, President of the Foundation for Subsidiarity; Maria Cristina Pierro, Rector of the University of Insubria; Michele Castelli, Associate Professor of Political Science at the University of Milano-Bicocca; Camilla Callegari, Director of the Complex Psychiatry Unit in Varese and of the Department of Mental Health, Prevention and Addiction Care at ASST Sette Laghi; Carlo Nicora, General Director of Fondazione Molina, Varese; Francesca Rovera, President of the School of Medicine of the University of Insubria; and Sergio Segato, Director of the Department of Digestive Diseases, Nutrition and Metabolism at ASST Sette Laghi. Greetings were also delivered by Davide Galimberti, Mayor of Varese, and Marco Magrini, President of the Province of Varese.

In comparison with other European countries, Italy shows an overall favourable performance: in 2023, the share of people reporting unmet healthcare needs stood at 2%, compared with the EU average of 3.8%. When considering only barriers related to the functioning of the healthcare system – excessive costs, distance from services or long waiting lists – the Italian figure falls to 1.8%, compared with 2.4% at European level. However, behind the national average lie significant disparities linked to income, geographical area and type of healthcare service.

The main challenge concerns the transition from formal universalism to effective universalism: the right to healthcare is guaranteed to everyone, but the ability to access specialist consultations, diagnostic tests and care pathways in a timely manner still depends too much on where people live and on the resources available to them.

Socio-economic differences are particularly evident. In Europe, 2.2% of people in the lowest income quintile report being unable to access the healthcare they needed because of costs; the figure falls to 0.2% among those in the highest income quintile. In Italy, the gap is even wider: 2.9% of people in the lowest quintile forego healthcare for economic reasons, compared with 0.2% in the highest quintile.

Foregoing healthcare services confirms this trend. At national level, around 10% of respondents had to forego a specialist consultation despite needing one, while around 6% had to forego a diagnostic test. The rates decrease as income rises: around 12% of people in the lowest quintile forego specialist consultations, compared with 8% in the highest quintile; for diagnostic tests, the figure falls from 7.5% to 5%.

The barriers are not only economic. For specialist consultations, waiting lists are cited as the reason for foregoing care by 50% of respondents, while excessive costs account for 46.7% and distance from services for 10.8%. For diagnostic tests, waiting lists rise to 52.8%, followed by costs at 45.9% and distance at 10.4%.

Although the resources available to the National Health Service (SSN) have increased, from €114 billion in 2019 to €136.5 billion in 2025, with €142.8 billion forecast for 2026, the Report highlights that the issue is not only how many resources are allocated to healthcare, but also how they are transformed into value for citizens.

The growing needs arising from ageing, chronic conditions, vulnerability and long-term care require a less fragmented system, better able to integrate healthcare, social and healthcare services, and community-based care.

Maria Chiara Gadda, Member of Parliament and member of the Parliamentary Intergroup for Subsidiarity, said: “Chronic conditions and social and healthcare needs are constantly increasing. Our National Health Service has many areas of excellence, but our society has changed considerably. We need a change of pace in our organisational model and towards a more mature relationship between public administration and the Third Sector. The European Union’s Action Plan for the Social Economy confirms the importance of this sector, made up of non-profit organisations, cooperatives and associations, without which many social and healthcare services would already be struggling. These organisations cannot only be involved at the end of the process: they must be able to co-plan and co-design responses to people’s needs together with public institutions.”

Giorgio Vittadini, President of the Foundation for Subsidiarity, commented: “The right to healthcare must be protected more strongly. Universalism cannot be reduced to the formal recognition of a right: it must translate into the concrete possibility for every person to receive appropriate and timely care. The National Health Service remains one of the country’s most important social infrastructures: it not only protects health, but also strengthens social cohesion, drives development and represents an essential condition for democracy. This is why we need greater subsidiarity: a qualitative leap in public governance, which is called upon to ensure equity in access, quality of services and continuity of care, bringing together everyone’s contribution for the common good. In this sense, subsidiarity is the institutional architecture of universalism.”

Maria Cristina Pierro, Rector of the University of Insubria, stressed: “The sustainability of the National Health Service is not simply a matter of resources; it also requires the ability to turn those resources into concrete responses to people’s needs. In this challenge, universities are strategic actors: they train healthcare professionals, produce research and innovation, and place their expertise at the service of the local community. Subsidiarity is the method for building a system, bringing together institutions, healthcare, universities and communities in a shared responsibility.”

Particular attention was also devoted to the Lombardy healthcare system.

The Report identifies the areas requiring action. In particular, according to the latest monitoring of the essential levels of care (LEA), community-based care, with a score of 76, has greater room for improvement than prevention, which scores 95, and hospital care, which stands at 86. Strengthening coordination between hospitals and community-based services, home care and the integration of healthcare and social services therefore appears essential to ensure more continuous care, particularly for older people and those living with chronic conditions or vulnerabilities.

Another area of concern is healthcare staffing: Lombardy has 5.63 doctors and nurses employed by the National Health Service per 1,000 inhabitants, compared with an Italian average of 6.1. The presence of general practitioners and paediatricians is also below the national average, resulting in a higher patient workload for primary care doctors. Contributions from local healthcare representatives helped relate these challenges to the concrete experience of the area, highlighting the need to enhance professional expertise, improve continuity of care and develop closer cooperation between institutions, healthcare facilities and social organisations.

The “Sussidiarity and… Health” Report, the nineteenth annual report of the Foundation for Subsidiarity

Produced in collaboration with academics and researchers from: BReCHS Bicocca Research Centre in Health Services at the University of Milano-Bicocca, Bocconi University, Brunel University of London, the Institute for Finance and Local Economics (IFEL), Ca’ Foscari University of Venice, the University of York, Università Cattolica del Sacro Cuore, the University of Parma, the University of Pavia, the Management and Health Laboratory (MeS) of the Sant’Anna School of Advanced Studies in Pisa, and the University of Verona.

(In the photograph, from left: Giorgio Vittadini, Maria Chiara Gadda, Maria Cristina Pierro, Giancarlo Giorgetti and Fabio Tamburini)