National Health Service

Italy’s national health service (Servizio Sanitario Nazionale/SSN) was established in 1978 and replaced the previous system of state insurance founded after the Second World War. The aim of the SSN was to create an efficient and uniform health system covering the entire population, irrespective of income or contributions, employment or pre-existing health conditions. The SSN provides free or low-cost health care to all residents and their families plus university students and retirees (including those from other EU countries) and emergency care to visitors, irrespective of their nationality.
In 1998 the SSN was separated from the INPS (see page 275) and funded directly by central government via the IRAP tax (Imposta Regionale Sulle Attività Produttive), which is paid by employers on behalf of employees; the self-employed pay for themselves through their taxes. You don’t pay direct contributions and need only be a resident in Italy or a citizen of the EU to receive the same health benefits as an Italian. If you qualify for health care under the SSN, your dependants receive the same benefits and are listed on your card. Dependants include your spouse (if she isn’t personally insured), children you support who are under the age of 16 (or under the age of 26 if they’re students or unable to work through illness or invalidity), and ascendants, descendants and relatives by marriage supported by you and living in the same household.If you aren’t entitled to public health benefits through payment of Italian taxes or by receiving a state pension from another EU country, you must usually have private health insurance and must present proof of this when applying for a residence permit. If you’re a retired EU national planning to live permanently in Italy, you need form E121. EU citizens who retire before qualifying for a state pension can receive free health cover for two years by obtaining form E106 from their country’s social security department. If the temporary cover expires before you reach retirement age, you need to make voluntary social security contributions or take out private health insurance (see page 282).
The SSN is largely under the control of regional governments and is administered by local health authorities (Azienda di Sanità Locale/ASL – often referred to by their former name Unità Sanitaria Locale/USL). The SSN provides hospital accommodation and treatment (including tests, surgery and medication during hospitalisation), visits to family doctors (GPs), specialist medical assistance provided by paediatricians, obstetricians and other specialists, discounted medicines, laboratory services, appliances, ambulance services and free services at a local health unit (consultorio).
Those who are registered with the SSN are entitled to free or subsidised medicines (see page 258), a 75 per cent reduction on the cost of  out-patient and after-care treatment, and some subsidised dental treatment (see page 264). All in-patient treatment, i.e. treatment requiring hospitalisation is free under the national health service. Many medical expenses can be totally or partially deducted for tax purposes, including the cost of spectacles, hearing aids and visits to medical specialists, so you should retain all medical receipts.The Italian health service places the emphasis on cure rather than prevention and treats sickness rather than promoting good health. There’s little preventative medicine in Italy such as regular health checks. The public health service has limited resources for out-patient treatment, nursing and post-operative care, geriatric assistance, or terminal illnesses and psychiatric treatment. Inadequate treatment due to staff shortages and long waiting lists as a result of a lack of hospital facilities are frequent complaints made against Italy’s health service. Many problems are related to crippling bureaucracy, mismanagement, general disorganisation and spiralling costs. Despite the huge advances in medicine and the progress in health care in Italy in the last few decades, the public health service is facing enormous problems. Health service reform is a matter of intense public debate in Italy and it’s likely that there will be major changes in the next decade.
Registration
You must register for membership of the SSN at your nearest local health authority (Azienda Sanità Locale/ASL), whose address you will find under ASL or USL (pronounced ‘ahsle’ and ‘oosle’) in your local telephone directory. You need to take the following documents with you, as applicable:

• Your permit to stay or residence permit (see pages 79 and 86);
• Your passport or other official identity document, such as an Italian driving licence;
• A family status certificate (certificato di stato di famiglia) if you want to claim benefits for your spouse or children (see Applications on page 84);
• Your fiscal code card (see page 295);
• A letter from your employer stating your employment start date (dichiarazione de datore di lavoro) and a statement from the INPS (see page 275) that you’re regularly employed or a registration card (attestato di iscrizione) from the unemployment office (Ufficio di Collocamento) or proof of admission from an approved educational establishment.

Once you’ve completed the registration formalities, you’re asked to choose a family doctor (see below)with a social security agreement (convenzionato or con la mutua) and, if you have children under six, a paediatrician (pediatra). You and each member of your family are issued with a national health number and receive a health card (tessera sanitaria) in which all medical occurrences, e.g. illnesses, general medical care and surgery, are recorded. Health cards are valid for a year and must be renewed (stamped) annually; if you lose your card or change your address, you must apply for a replacement.
There are certain health requirements for employees and schoolchildren in Italy. Employees who work in the food industry (bars, restaurants, food shops, factories producing food products, etc.) must obtain a health record book (libretto sanitario) from the public hygiene office at the town hall and undergo an annual medical examination. Schoolchildren at lower and upper secondary school are required to produce a medical certificate (certificato di sana e robusta costituzione fisica) from their school before participating in any sports activities. Participation in a competitive sport (sport agonistico) also requires a medical examination, which must be conducted by a specialist in sports medicine, usually at a local sports centre or your local health authority. Medical examinations for participation in sports activities are free under the national health scheme.If you travel abroad frequently, a good way of keeping detailed health records for your family is to obtain an EU health passport (passaporto sanitario), which is printed in eight languages and available free from pharmacies.

This excerpt has been republished with permission from Survival Books. Some of the information may apply to EU citizens only.  If you would like to get the inside track on moving to Italy, pick up your copy of this great book by clicking here.