Italy is one of the world’s most visited destinations, meaning frequent interaction with its healthcare system. But for international payers, assistance providers, and medical networks, a range of challenges are often faced.

Issues around decentralisation and national administrative practices still exist, although efforts are underway to smooth the process.

Italy’s national health service, known as Servizio Sanitario Nazionale (SSN), was founded in 1978. It is a nationally funded, regionally managed system giving coverage for all residents and European Union (EU) citizens, with a strong primary care network and a relatively high doctor-to-patient ratio. However, both access and quality of care are inconsistent across the country due
to a range of challenges, including regional disparities.

Antonio Magliocca, Medical Director and Founder of BMC h24 Travel Assistance, explained: “In 2025, Italy offers high-quality medical care and a strong network of hospitals, but it is not always equipped to accommodate international payers. Despite the clinical excellence, administrative and structural barriers persist – especially in smaller inland cities, where staff are often unfamiliar with international protocols.” On the other hand, he explained, tourist-orientated cities are gradually improving.

Cities with high tourist volume such as Rome, Milan, Bologna, Rimini, and Jesolo are taking steps by setting up dedicated teams to support international patients, offering assistance with accommodation, native-language support, discharge coordination, and repatriation.

However, “international payers still face challenges such as bureaucratic delays and inconsistent communication between public and private sectors”, Magliocca pointed out. “Private providers tend to be more responsive, offering more support.”

Funding challenges

In addition to these challenges, Tatiana Malyshka, Manager of the International Office of Humanitas Research Hospital in Milan, believes that the global financial crisis played an important role.

“After 2008, funds began to be stretched at national health service organisations, leading to greater demand on the private side, which started attracting more private patients and international patients,” she explained.

Private insurance will continue to grow, she believes, not least because the decentralised nature of Italy’s healthcare system creates complexity for both patients and international insurers.

These regional disparities in healthcare quality can be significant. “In the north – regions like Lombardy or Emilia-Romagna – facilities generally appear more modern, better staffed, and more efficiently managed, reflecting higher local investment and better infrastructure,” Dr Jon Sen, Medical Director of the Mayday Group, said. “In contrast, southern regions such as Calabria, Sicily, or Campania often suffer from underfunding, longer wait times, fewer specialists, and generally lower service quality. This north-south divide means a tourist’s healthcare experience can vary drastically depending on location.

Private insurance will continue to grow ... not least because the decentralised nature of Italy’s healthcare system creates complexity for both patients and international insurers.

“For example, tourists needing urgent medical attention in Milan may receive quicker and more comprehensive care than someone in Naples or Palermo. Additionally, the south often contends with medical personnel shortages and hospital mismanagement, further complicating access for non-Italian speakers.”

From a claims processing perspective, this can lead to significant regional differences in efficiency and service quality, with northern regions generally offering more streamlined services than the south.

“This fragmentation makes it difficult to establish uniform practices across the country,” explained Giovanni D’Antonio, Head of Accident and Health, Insurance, for Italy at Sompo. “There are significant disparities between geographic regions in terms of claims processing efficiency and healthcare delivery.

“There is also a lack of standardised procedures,” he added. “The absence of clear and uniform guidelines hampers predictability in claims outcomes, a challenge less prevalent in other European countries.”

Billing issues

One effective approach to tackle these challenges has been developed by Malyshka at Humanitas, the second biggest private healthcare group in Italy, with a Joint Commission International (JCI) accredited research hospital.

In 2014, the hospital set up an internal international office to extend provision for international patients, who don’t have Italian public coverage. They have special requirementsand needs, such as an interpreter or medical visa, to enable them to access treatment.

Malyshka created best practice procedures for international patients at her hospital, and for their insurance and legal requirements. The international office provides services that help medical staff at the hospital deal with cultural differences before and during the international patient’s hospital stay.

“The office has been open 11 years,” she said. As an internal office, it supports the hospital with private, out-of-pocket, international patients, in addition to holders of private international insurance policies. “We aim to promote the automation of processes so they can prioritise the human touch,” she explained.

In Italy, invoices for medical care must, by law, be issued to the patient, not the insurer

A huge challenge faced by Malyshka and others managing international patients is the need to directly issue invoices to the patient, not the insurer. “In Italy, invoices for medical care must, by law, be issued to the patient, not the insurer,” Malyshka said, because the invoice is tied to the patient’s tax code. Details are reported to the tax authorities, and even when an insurer is going to cover the cost, the provider must record the patient as the recipient of the service.

They try to be flexible, Malyshka said, but direct billing is only possible when there’s a formal agreement in place between the hospital and insurer. “We’ve tried to find the best solution for international partnerships, but often we have to inform patients/insurers that’s just how it is, that’s the law.”

Nevertheless, within the country there are improvements taking place across regions in terms of billing, with some regions introducing clearer billing structures as well as multilingual contact points in public hospitals to better serve foreign patients.

These changes are occurring partly in response to evolving policyholder expectations, supported by digitalisation and a growing demand for transparency.

Tech trends

Among the major growing trends are centralised booking systems, e-prescriptions, and electronic health records (EHRs). The country is currently moving towards the adoption of EHRs, specifically through the Fascicolo Sanitario Elettronico (FSE), as part of a formal national strategy. The move is underscored by national legislation designed to create a unified digital health record for every citizen, which was adopted in May 2022.

This digital transformation will improve service efficiency and accessibility, said D’Antonio. “Digitalisation efforts aim to improve healthcare services, minimise inefficiencies, and improve the cost-quality ratio, aligning with policyholders’ expectations for more streamlined claims processes,” he believes. “Additionally, policyholders now expect personalised healthcare services that address their specific needs, reflecting broader trends in consumer-centric healthcare.”

Both doctors and patients have increasing confidence in modern remote approaches

Radmila Sarkisian, Head of Operations and Network at AP Companies, agreed. Digitalisation has driven significant improvements, she said. “Online booking has slashed scheduling delays (e.g. specialist wait times down 15–20%), and telemedicine has introduced lower-cost triage options, although complex treatments remain cost-intensive.”

Telemedicine also helps patients decide on the right specialist for them before making the journey. Equally, “since Covid, doctors no longer feel they need to see the patient in person in advance of giving treatment”, Malyshka said.

She also feels that both doctors and patients have increasing confidence in modern remote approaches such as the use of artificial intelligence (AI). “For a lot of things, people will stop coming to the hospital,” she said.

The growing use of digital tools, together with a more open approach to cross-border cooperation, are promising signs. “With further alignment to international expectations, Italy has the potential to become a more accessible and reliable healthcare destination for international insurers and patients alike,” hopes Magliocca.

Aligning with international standards

With Italy’s willingness to participate in EU-level coordination, particularly in emergency preparedness and data-sharing, the country is showing “a strong commitment to aligning with international standards of efficiency and transparency”, Magliocca said. “These improvements mark important progress toward a more modern, accessible, and internationally compatible healthcare system.”

Despite some shortcomings in how the public system handles international patients, the overall value for money offered by Italian healthcare is excellent, for both straightforward and more complex services. However, the experience can still vary due to administrative delays and inconsistent communication. For complex or urgent cases, use of an experienced and transparent intermediary who can navigate the system is very beneficial for identifying the most appropriate facility while helping to contain costs and ensuring timely care. This improves outcomes and prevents situations from escalating into more difficult or expensive scenarios.

Dr Sen fully agrees with the need to adequately prepare before visiting the country. “While Italy’s long-term commitment to universal care is commendable, systemic and regional issues can make healthcare access and effectiveness very challenging for foreign nationals, emphasising the importance of robust travel insurance and preparation before visiting the country.”

A well-structured intermediary role may also be necessary to bridge expectations across a complex national landscape

A global medical assistance provider like AP Companies can manage these intricacies seamlessly by leveraging regional relationships, Sarkisian explained, to accelerate care and streamline administrative processes. “In high-demand zones, we expedite care through premium networks. In remote areas, we leverage public-private hybrids or coordinate medical transfers including air ambulances, if required.”

For improved cost containment, an assistance provider can audit invoices line by line, challenging surcharges and benchmarking against local customary rates.

A well-structured intermediary role may also be necessary to bridge expectations across a complex national landscape.

Increasingly, too, hospitals are rethinking how to manage private and international patients. Eventually, insurers and healthcare systems “will no longer be national but international”, Malyshka anticipates, giving more choice of specialists from a global pool. “Private patients will not be choosing a country to be treated in but their chosen international provider – the best specialist, wherever in the world they are.”

For now, though, navigating Italy’s decentralised, hybrid public-private system while maintaining cost transparency requires local expertise. Understanding these disparities remains a challenge. Effective treatment organisation and claims handling for international patients relies on trusted intermediaries with their trusted local partners and on-the-ground expertise.