The health service, family doctor and hospital

How the system is built

Italian healthcare is public, universal and funded from general taxation, but it is organised by the regions. The principles are national; the details — what a test costs, how long you wait, how you book — change as you cross a regional border.

The body you deal with is called the ASL across much of Italy, but also AUSL, ATS, ASST or AST depending on the region. It is the same thing.

Registering

Who is entitled to compulsory, free registration

• Anyone working in Italy, employed or self-employed, and their dependent family members.
• Anyone registered as unemployed with the employment centre, with dependants.
• Pensioners from another EU country presenting the S1 form issued by the social security body of the country paying the pension: care is delivered in Italy and charged to that country.
• People falling into protected categories set out in law.

Who registers voluntarily

Someone resident in Italy but outside the above — for instance living on capital, without work and without a foreign pension covered by an S1 — may register voluntarily by paying an annual contribution.

What to bring to the ASL

• Identity document and tax code.
• Certificate of residence or self-declaration, or a declaration of habitual dwelling.
• The entitlement itself: employment contract, payslips, S1 form, employment centre registration.
• For non-EU nationals: the residence permit.

At the end you choose your doctor and receive, by post over the following weeks, the tessera sanitaria, which carries the European Health Insurance Card on the back for travel.

And in the meantime?

Until registration, anyone from an EU or EEA country or Switzerland is covered by the European Health Insurance Card (EHIC) for care that becomes necessary during a stay. It does not cover planned treatment, and it does not replace registration once you are resident.

Anyone from outside the EU has no such cover: until registration you need private health insurance, which is often already required for the visa. Urgent care in an emergency department is always provided, but can be billed.

The family doctor

You choose one at the ASL from a list of local doctors with places free. They are the pivot of the system:

• visits are free, at the surgery or at home where needed;
• they prescribe medicines and tests: without their prescription many services are paid in full;
• they refer you to specialists and certify sickness for work.

For children up to 14 you choose a paediatrician (pediatra di libera scelta), compulsory up to age 6.

You can change doctor at any time, at the counter or online, without explaining why. If you move to another ASL, the choice must be made again.

Booking appointments and tests

With your doctor's prescription you book through the regional CUP — by phone, at a counter, at a pharmacy or in the region's app. The prescription carries a priority class setting the time within which the service must be provided: urgent, short, deferrable, planned.

If the CUP cannot find a slot within that time, many regions run a protection procedure entitling you to have it done in a private or hospital-private setting paying only the co-payment. You have to ask: it is not offered.

The co-payment (ticket)

Not everything is free. The ticket is the patient's share for specialist visits, tests and some medicines, set by the region.

There are exemptions, which must be claimed and which apply for:

• income combined with age (children, over-65s below a threshold, unemployed);
• chronic illness or rare disease;
• disability;
• pregnancy and prevention pathways;
• organised cancer screening, free for the age groups invited.

Your family doctor and the ASL know which code you qualify for. It is not automatic: you request it.

Accident and emergency

A&E is for emergencies. On arrival a nurse performs triage and assigns a priority code: you are seen in order of severity, not of arrival. With a low code the wait can run to many hours, and that is normal, however unfair it feels.

• 112 is the single emergency number: police, ambulance, fire. Free, works without credit.
• For problems that are not emergencies but cannot wait for your family doctor — at night, at weekends, on public holidays — there is the out-of-hours doctor (continuità assistenziale). In several regions you reach it on 116117.
• Pharmacies run duty rotas: the one open is posted on every other pharmacy's door and on the municipality's website.

What surprises people arriving from abroad

• Dentistry is almost entirely private. The public service covers only certain groups and certain emergencies. Budget for it.
• Pharmacies do far more than sell. The pharmacist advises, measures blood pressure, runs some rapid tests, and in many regions books appointments.
• The family doctor is a person, not a clinic. They have their own surgery, their own hours and often a direct phone number.
• Public waiting lists can be long, and an accessible private sector sits alongside. Asking for the protection procedure before paying privately is almost always the right move.
• The electronic health record collects results and prescriptions and is accessed with SPID or CIE.

Common mistakes

• Postponing registration and relying on the EHIC: it covers care needed during a stay, not life as a resident.
• Not requesting the S1 form before leaving, if you are a pensioner from a country that issues it.
• Arriving from outside the EU without private insurance, counting on a registration that takes weeks.
• Not choosing a family doctor: without one, every prescription and certificate becomes a problem.
• Not claiming an exemption you are entitled to, and paying co-payments for years.
• Going to A&E instead of calling the out-of-hours doctor.