ROME, May 3, 2025 – Italy’s National Health Service is on the brink of collapse, with patients suffering in agony to access emergency medical care, forcing many to queue for months, journey long distances, or seek treatment privately. Lying beneath the crisis lies an acerbic struggle between national and regional governments, whose failure to cooperate is pushing an already straining system to the limit. As millions of Italians move through a system in disarray, one is left to ask: how did the country renowned for its system of socialized medicine come to this, and what are the signs of what lies in store for its future?
A Breaking Point in the System
The ordeal of patients like Francesca Mannocchi, an award-winning journalist with multiple sclerosis, has been synonymous with the health care crisis in Italy. Mannocchi attempted to book a routine but essential MRI scan in her nearby public clinic and was faced with reality: there were no appointments available—not next month, not next year. The soonest time was in July 2025, more than one year from the time, and involved a 90-kilometer journey to a private clinic in a different province. Without options in the public system, Mannocchi turned to the private sector to deal with the “urgent” designation on her medical record.
Mannocchi’s ordeal, which set off a firestorm of public indignation after going viral throughout Italy, is far from an isolated incident. Thousands of Italians in dire need of medical attention are presented with the same dilemma: wait months, or even years, for necessary care, travel absurd distances, or pay what is often more than most can manage for private care. One report from CENSIS found that 34.9% of those Italians who try to make appointments with the public health system give up and turn to private providers for care. For those without financial means, the option is very often not receiving care at all—an option that has disastrous repercussions.
Statistics collected by Il Post are worse still. According to Italian law, the “short-priority” medical consultations, defined as urgent, are supposed to take place in 10 days. Patients actually wait 180 waiting days for urology consultations, 127 waiting days for vascular consultations, and 120 waiting days for those of ophthalmology. As for “deferrable” ones, to be conducted in 30 days, things are worse: cardiology and neurology consultations are ready after 300 waiting days, and those of pulmonology after 282 waiting days on average. Oncology consultations, essential in cancer patients, are the only one in acceptable times, but these are subject to delay in some cases.
A Political Standoff Exacerbates the Crisis
Italy’s medical emergency is not solely the product of decades of under-funding and structural inefficiency but also growing political divide between the state and the nation’s 20 regions, that are constitutionally charged with planning health care. The government, led by Health Minister Orazio Schillaci, has submitted the draft of a proposed decree that reduces waiting lists by allowing the central state to interfere with poorly performing regional health systems. The draft has been vigorously resisted by regional officials, who view it as an interference with constitutional autonomy.
All regions rejected the latest version of the decree in March 2025, arguing that the vague language and discretionary authority in it can be used as a political tool. Tuscany President Eugenio Giani, among the vocal opponents, stated that the tool will allow the government to penalize opposition-held regions while ignoring underperforming allies. The opposition is bipartisan with right-wing governors equally condemning what is perceived as a dangerous precedent.
In the opinion of the government, intervention is not only justified but is required. Schillaci has cited one Carabinieri health check that revealed deep-seated irregularities in 27% of the health units in the area, including the illicit “closing agendas” technique used to deny appointments to citizens in the first place. The public health centers are legally required to offer appointments, even farming these off to certified private providers if that is what it takes. Schillaci believes that regional inefficiency and mismanagement require stronger central control to restore function to the system.
The standoff has brought progress to nought. A 30-day window is now available to both sides in which to come to some sort of agreement regarding the decree. Failing that, the government will bypass regional assent and impose the decree unilaterally, and what will happen is that it will inevitably trigger a legal battle with the regions in the Constitutional Court. That will further harden the political standoff, and the patients will suffer the consequences.
Patients Caught in the Crossfire
While the political game of “blame game” is on, common Italians are paying the price. Nino Cartabellotta, the director of the GIMBE Foundation, a non-political civil society that promotes evidence-based health policy, has termed the standoff to Euractiv as “blame game to bury the evidence of an all-too-predictable collapse.” He argues that the political stalemate is keeping millions of Italians between shattered promises and administrative paralysis, with millions abandoning their search for care in frustration or sheer financial need.
Cartabellotta blames both regions and government. The government blames regions for sitting on €320m funded to clear backlogs created by the pandemic, but conveniently overlooks that its own accounting sleight of hand to produce a further €860m in waiting list elimination is not green shoots of new investment. Regions, meanwhile, complain of structural underinvestment and constitutional intervention but have taken no steps to address inefficiency, waste, or unsuitable care in their own systems. A national waiting list system, intended to measure and control waiting lists, was approved by the regions after several rounds of negotiation, only to be sat on by the government on its desk for nearly two months prior to publication—a microcosm of the general malaise.
A Gradual Disintegration of Form
“Long waiting lists are only the symptom,” Cartabellotta emphasized. “The disease is the deep, structural decline of the National Health Service in Italy.” Years of underinvestment, along with the aging of the population and rising health care demands, have brought the SSN to the breaking point. Italian health care spending, to remain fixed at 6.4% of GDP through 2028, is one of the lowest in Western Europe and puts the system in no shape to answer its problems.
Structural issues plague the system. There is not enough medical staff, due to low wages and burnout, to leave hospitals and clinics short. Digital infrastructure, that would assist in the planning and handling of appointments and patients, is severely lacking in most of the nation. Public-private arrangements, that would ease the load from the public system, are in disuse due to red-tape obstacles and ideological concerns. And inefficiencies—too many tests ordered or inefficient use of hospital facilities—continue to drain stretched budgets.
Cartabellotta warns that without sweeping, system-wide changes, the SSN risks further decline. He calls for greater investment in health workers, better digital infrastructures, and better use of private providers to backstop public services. These reforms would require political will and cooperation – things in short supply during this standoff.
A Cautionary Warning of Universal Health Care Italy’s health care crisis is a harsh reminder of the susceptibility of systems of universal care to chronic underfinancing and political disintegration. What was once a paradigm of universal care has been turned into a cautionary tale of what can happen if the system’s flaws are not corrected. For patients like Francesca Mannocchi, the choice is blunt: Wait and endanger life by prolonging treatment indefinitely, journey unaffordably far, or purchase care to which public entitlement but not public availability exists. As government and regions are in standoff, the toll in human lives continues to grow. Unless finally there is a common sense of urgency to place patients above politics, the Italian healthcare system threatens to become something that is reminiscent of the past and unable to assist the very men and women it was intended to treat. Time is short, and time is no longer something that millions of Italians in good conscience can afford.
