While European financial governance imposes on Italy a rigorous trajectory of recovery from public debt, at the same time it draws attention to the stability of the National Health Service. In the Country report 2026 of the European Commission is defined as a strategic asset that cannot be an ancillary expenditure item. The future competitiveness and stability of the country is at stake.
It is precisely in this narrow margin between budget constraints and performance protection that the Gimbe Foundation’s latest report is inserted, based on data from the dataset OECD Health Statistics.
How much Italy spends compared to Europe
According to the data reported by the study, public health spending per capita, calculated at purchasing power parity, places the country in 15th place among the 27 in the OECD area, last among the G7 nations. We spend around 36.1 billion euros less than the average.
Within the European Union, 14 member states allocate a higher share of resources to public health than Italy, with differentials ranging from 0.2 percentage points in the Slovak Republic to 4.8 percentage points in Germany.
| EU state | Health spending per capita (in $, at purchasing power parity) |
Health expenditure (% GDP) |
|---|---|---|
| Germany | 6,831 | 10.9% |
| France | 5,622 | 10.3% |
| Austria | 5,879 | 9.2% |
| Netherlands | 5,738 | 8.9% |
| Belgium | 5,402 | 8.8% |
| Sweden | 5,318 | 8.7% |
| Denmark | 5,497 | 8.6% |
| Luxembourg | 5,882 | 8.6% |
| Finland | 4,406 | 7.5% |
| Ireland | 4,823 | 7.4% |
| Spain | 3,372 | 7.3% |
| Slovenia | 3.203 | 7.1% |
| Portugal | 2,845 | 6.9% |
| Czech Republic | 3,125 | 6.8% |
| Slovak Republic | 2,381 | 6.4% |
| Italy | 3,255 | 6.2% |
| Cyprus | 2,204 | 6.0% |
| Lithuania | 2,518 | 5.9% |
| Greece | 1,972 | 5.8% |
| Estonia | 2,385 | 5.6% |
| Croatia | 2.012 | 5.5% |
| Malta | 2,415 | 5.4% |
| Poland | 2,210 | 5.3% |
| Hungary | 1,915 | 5.1% |
| Latvia | 1,854 | 4.8% |
| Romania | 1,610 | 4.7% |
| Bulgaria | 1,520 | 4.2% |
A negative post-Covid trend
The analysis of the data highlights a divergence between Italy’s financial planning choices and those of its continental partners. In general, the economies of the EU area have made the increases in health spending initiated during the acute phase of Covid-19 structural, maintaining the impact on GDP above pre-pandemic levels, Italy has progressively reduced the extraordinary flows of financing.
The share of health spending compared to total Italian public spending fell from 13.8% in 2019 to 13.2% in 2024, compared to overall public spending that grew from 48.4% to 50.4% of GDP in the same period of time. The contraction in health spending in relation to GDP reflects a budget policy aimed at reducing emergency deficits.
The crux of privatization and out-of-pocket spending
The reduction in public coverage has generated a growing share of the demand for services shifting towards the private sector. Eurosystem findings indicate that healthcare expenditure borne directly by families (out of pocket) reached 23.7% of total health spending. A value that exceeds the European average of 14.9%.
The country’s healthcare is becoming de facto private. The process is fueled by the difficulties of the National Health Service in managing waiting lists and in homogeneously covering the Essential Levels of Assistance. As emerges from the Istat data cited by Gimbe, the lengthening of access times to public facilities has pushed over 5.8 million citizens to give up specialist visits and tests, while those who have the financial means resort to paid services or private insurance coverage.
The macroeconomic context and public finance constraints
The trend in health spending is directly intertwined with the country’s macroeconomic constraints. On the public finances front, the public administration deficit stood at 3.1% of GDP in 2025. For the three-year period from 2025 to 2027, the ratio between public debt and GDP is estimated to reach up to 139.2%. According to analyzes by the European Commission, the margins of flexibility in the budget are being eroded in particular by social security spending, which alone accounts for 40%.
Not to mention the demographic winter that Italy is going through. By 2050, the country’s population aged between 15 and 64 will fall to 54.3% of the total compared to 63.5% in 2024. People over 65 will reach 24.7% of the population in 2025, compared to a European average of 22%. This also means a structural increase in demand for health services related to ageing.
The short circuit on regional budgets and European indications
Nino Cartabellotta, President of Gimbe, defines the level of public financing as a structural criticality that impacts the provision of services and the stability of regional budgets. Healthcare, in fact, alone constitutes almost 80% of a Region’s budget.
When the State does not adjust the resources allocated to healthcare to cover the real costs of inflation, energy increases or staff contract renewals, the Regions are still faced with the need to continue to provide Essential Assistance Services. And one of the ways they can rebalance spending is by cutting other services or raising local taxes, increasing the rates of additional IRPEF and IRAP.
A problem that is both economic and social, which is linked to the monitoring and warnings of international financial institutions:
- the European Commission recalls the need to pursue medium-term budget sustainability and debt reduction, without ignoring social protection systems;
- The International Monetary Fund and WHO underline the need to balance budget rigor with interventions aimed at containing private healthcare spending, avoiding its regressive impact on family incomes.
