In Italy, ASL stands for Azienda Sanitaria Locale, or Local Health Authority. Sometimes you’ll see AUSL or USL depending on the region, but they refer to similar bodies. ASLs are public organizations responsible for providing most local and territorial health services under the Servizio Sanitario Nazionale (SSN).
👉 For a full overview of how the Italian health system works, see our guide: Italian National Health System (SSN) Explained.
What They Do & Services They Offer
ASLs deliver local health services: they often break down into districts (Distretti sanitari) which coordinate services like family doctors, vaccination, health promotion, home care, and public health. ASLs also oversee diagnostic labs, outpatient clinics, mental health services, preventive medicine, environmental health, and sometimes manage small local hospitals. More complex hospital services are often handled by Aziende Ospedaliere (AO), though ASLs fund and commission them.
When you choose your Medico di Base (family doctor), that happens through your ASL. Your ASL also handles vaccinations, health screenings, assistance for chronic conditions, home care and more.
How to Contact & Book an Appointment
Each region maintains its own ASL directory and contact info. Many ASLs list offices, numbers, emails, and online booking portals on their regional health websites.
To book an appointment through ASL services:
- Obtain a referral or Impegnativa from your doctor.
- Use the CUP (Centro Unico di Prenotazione) system linked to your ASL (online, by phone, at ASL counters or partner pharmacies).
- Provide your Tessera Sanitaria number, fiscal code, and referral code.
- Choose your preferred ASL facility or district clinic.
Once booked, you’ll receive confirmation with date, location and sometimes floor/room. At the clinic, you must present your health card and the referral.
When You Arrive & Paying for Services
When you arrive for your exam or service, bring:
- Tessera Sanitaria
- Referral/Impegnativa
- Any payment receipt if you paid in advance
If a ticket (co-payment) is required, you’ll often pay at ASL counters, kiosks within clinics, or via PagoPA online prior to the appointment. Some regions require proof of payment before accessing the service.
If you’re exempt from the ticket (due to income, age, chronic illness), the exemption code should appear on your referral. ASL staff will verify it.
Special Notes & Limitations
Not all services are fully managed by ASL. Hospitals, surgical intervention, and specialized care may fall under hospital trusts. ASLs coordinate and refer you to them.
Quality and wait times can vary significantly depending on region. Some ASLs in Northern Italy operate faster; others in southern or rural areas might struggle with delays or staff shortages.
Foreigners legally resident in Italy are covered by the ASL system once registered with the SSN and picking a Medico di Base.
ASL in Le Marche: ASUR and AST explained
In Le Marche, healthcare services have become increasingly centralised. Smaller hospitals and many local ambulatories have been closed or repurposed. This means that people in rural areas often need to travel further for specialist care, diagnostics, or emergency treatment.
The region used to operate under the Azienda Sanitaria Unica Regionale (ASUR) model. That structure was abolished in 2022, and replaced with five provincial Aziende Sanitarie Territoriali (AST). This change means that you might still see “ASUR” or “ASL” mentioned in older documents, but the current system in Le Marche is AST-based and locally managed within each province.
Across Italy, the terminology varies from region to region. For example, Emilia-Romagna uses AUSL (Azienda Unità Sanitaria Locale), while Veneto and Lombardia prefer ULSS or ATS. Despite the different names, these bodies all serve the same purpose.
Key Takeaways
- ASL (Azienda Sanitaria Locale) is the local health authority that handles territory-based medical services.
- It evolved from earlier USL structures in the 1990s to become semi-autonomous.
- ASLs manage primary care, preventive health, outpatient services, local diagnostics and coordinate hospital care.
- To use ASL services you need a referral, an ASL-linked booking via CUP, and your health card.
- Payments (ticket) are handled via ASL counters or online, unless you qualify for an exemption.
- Regional differences exist — what you experience with ASL in one region may differ in another.