The SSN (Servizio Sanitario Nazionale) is one of the pillars of Italy’s welfare state. Founded on the idea of universal access to healthcare, it guarantees medical services to all residents, regardless of income or nationality. While the National Health System remains a source of pride for many Italians, it also faces growing challenges such as underfunding, regional disparities, and long waiting times.
👉 Related: read our guide Understanding the Italian Welfare State.
History and Structure
The SSN was created in 1978, replacing an older system based on worker contributions. Inspired by the UK’s National Health Service, the Italian model was designed to provide free or low-cost care to everyone. Its foundation marked a major social reform, transforming healthcare from a privilege into a right.
The system is publicly funded, mainly through national and regional taxes, and managed at both national and regional levels. This means that while the Ministry of Health sets the general framework, each Regione organizes and delivers healthcare locally through its network of hospitals, clinics, and public health offices.
Universal Coverage: in Practice
All legal residents in Italy, including foreign residents with a Permesso di soggiorno (residency permit), have access to the SSN. Care is mostly free or involves small payments called ticket for specialist visits, lab tests, and prescriptions. Low-income individuals, the elderly, and people with chronic illnesses usually qualify for exemptions.
Private healthcare also exists in parallel, and some Italians choose private clinics or doctors for shorter waiting times or specific services. However, the majority of care in Italy is still provided by the public system.
The Family Doctor (Medico di Base)
Every registered resident must choose a Medico di Base (equivalent to a family doctor or a general practitioner). This general practitioner is your first point of contact for medical advice, prescriptions, and referrals. You can select your doctor at your local ASL (Azienda Sanitaria Locale) office.
The Medico di Base handles most everyday health needs and refers you to specialists using a document called an Impegnativa, a prescription form required for public services.
(We cover this in a separate article: What is an Impegnativa?)
Children up to the age of 14 are assigned a Pediatra di Libera Scelta (pediatrician), who plays the same role for minors as the family doctor does for adults.
ASL and CUP: Local Health Access
The ASL offices manage local healthcare services, including doctors, hospitals, vaccinations, and administrative tasks like registering for the SSN. Each region has its own ASL network, so processes and waiting times can differ widely.
To book visits or tests, citizens can use the CUP (Centro Unico di Prenotazione), a centralized booking system available online, by phone, or in person. Through CUP, you can schedule appointments with specialists, diagnostic exams, and lab services.
Pronto Soccorso: The Emergency Room
Emergency care in Italy is provided through Pronto Soccorso, the hospital emergency department. Anyone can access it, and it’s always free in life-threatening situations.
Upon arrival, patients are assigned a color code that determines priority:
- Red: critical emergency — immediate care
- Yellow: urgent, potentially serious
- Green: minor urgency — may wait hours
- White: non-urgent; may incur a fee
This triage system was introduced in the 1990s to standardize emergency response and manage overcrowding.
Ambulance Services: Croce Verde, Rossa, and Azzurra
Italy’s ambulance network is a mix of public and volunteer organizations:
- Croce Rossa Italiana (Red Cross): part of the global humanitarian network, active in major emergencies and disaster relief.
- Croce Verde: local volunteer associations providing emergency and patient transport services.
- Croce Azzurra: similar to Croce Verde, often community-based and run by local volunteers.
These organizations are coordinated by the 118 emergency number, which dispatches the nearest available team.
Challenges and Regional Differences
While the SSN guarantees care for all, the quality of services can vary significantly between regions. Northern regions like Emilia-Romagna, Lombardy, and Veneto tend to have better infrastructure and shorter waiting times. Southern regions may face staff shortages and limited hospital resources.
Budget pressures have also increased in recent years. Italy spends less on healthcare (as a percentage of GDP) than many Western European countries, leading to concerns about sustainability. Medical staff shortages, long waiting lists, and aging facilities are recurring issues.
Foreigners and the SSN
Foreign residents with a valid permesso di soggiorno can register with the SSN and access care like Italian citizens. EU citizens can use the European Health Insurance Card (EHIC) for temporary stays. Non-EU visitors without residence permits are usually expected to have private insurance.
For digital nomads, long-stay visa holders, or retirees, registration at the local ASL is essential to gain full access to public healthcare.
How to Register for the SSN
To register, bring the following documents to your local ASL:
- Passport or ID
- Codice Fiscale (Italian tax code)
- Proof of residence or rental contract
- Permesso di soggiorno (for non-EU citizens)
Once registered, you’ll receive a Tessera Sanitaria (Health Card), which includes your SSN number and allows access to all public services.
Key Takeaways
- The Servizio Sanitario Nazionale (SSN) provides universal healthcare to all legal residents.
- The system is publicly funded but regionally managed, so service quality varies.
- The Medico di Base is your main doctor, and the ASL and CUP handle local services and bookings.
- Emergency care (Pronto Soccorso) is accessible to everyone, with color codes defining urgency.
- Despite budget challenges, Italy’s health system remains one of the most inclusive in Europe.