access essential healthcare services, regardless of income or social status. Most services are provided free of charge or with a Italy faces a severe shortage of healthcare personnel, which is a major factor small copayment (ticket), with exemptions for certain income groups or chronic conditions. behind long waiting lists for diagnostic tests and surgeries.1 In 2024, Italy had about 4.2 specialist doctors and 6.5 nurses per thousand inhabitants, placing it behind major European countries such as Germany and France. Years of limited recruitment and The healthcare workforce is aging; 27% of specialists are over 65, which is the variation between regions. In fact, despite the Services are provided by both public and accredited private facilities, with some v highest rate in Europe. At the same time, many young doctors and nurses are leaving Italy for better salaries and working conditions abroad. This ongoing and central areas generally offering more advanced and higher-quality healthcare than the south. emigration, combined with a high number of unfilled training positions, puts the system at risk of an even greater shortage of medical staff in the near future. Italy also has one of the lowest hospital bed densities in the EU, with only 304 hospital beds in Italy decreased to 179,000 in 2023 (down by 20,000 since 2013). This limited capacity, combined with personnel shortages, further constrains access to surgeries, which are already considerable.2 The health insurance market in Italy has remained limited. Several factors contribute to this, including a low propensity among Italians to purchase individual policies due to the comprehensive public system, the high cost of premiums, the availability of health funds, and tax deductions for OOP healthcare expenses. Individual policies lack the fiscal advantages of supplementary health funds, as premiums are not deductible and are subject to a 2.5% tax, except for long-term care policies. In addition, insurance companies tend to exclude coverage for pre-existing. In 2021, public and private health expenditure in Italy accounted for 9.4% of GDP, more than 1.5 percentage points below the conditions and for services with a high risk of occurrence, which further limits the EU average. However, the trend is decreasing year by year. In 2023, the health expenditure in Italy accounted for 8.4% of GDP, appeal of these policies. Coverage is often partial, with deductibles and OOP leading to an absolute value of 176 billion. Italy's healthcare financing relies heavily on 00P payments (21.9%) and, to a lesser extent, voluntary health insurance (2.6%). direct payment to affliated providers or on reimbursement of expenses incurred. For Together, these sources made up 24.5% of total health expenditure in 2021, a share 30% higher than the EU average of 18.9%. these reasons, insurance companies have increasingly shifted their business toward About three-quarters of Italy's health spending is publicly funded, a share that is lower than the EU average of 81%. The inability of the National Health Service to provide timely care is increasing enrollment in private health funds, but economic challenges and inflation limit the ability to raise contributions. This willikely lead to higher OOP spending for those who can afford it, and greater unmet health needs among disadvantaged groups, resulting in worse health outcomes.