Italy’s health spending hits record levels, with private costs rising faster than public funding

Italy’s total health expenditure has reached almost €186 billion, marking a new record but also exposing growing imbalances within the system, according to the latest report by the State General Accounting Office.

Public health spending in 2024 amounted to €139.4 billion, up 4.9% on the previous year, while out-of-pocket spending by households rose much faster, increasing by 7.7% to €46.4 billion. The data confirm a structural shift, with a growing share of healthcare demand moving outside the National Health Service.

The report highlights mounting financial stress on regional budgets. Sixteen regions closed 2024 with deficits, pushing the overall regional shortfall to €2.57 billion, the highest level in a decade. To balance their accounts, many regions were forced to use their own resources, often cutting spending in non-health sectors. This points to a system that is spending more overall, but in an increasingly uneven and fragile way.

Cost growth is driven mainly by structural components. Personnel spending rose by 4.6%, direct pharmaceutical spending by 11.8%, and spending on goods and services by 9.3%. At the same time, spending on pharmaceuticals purchased directly by citizens and on specialist outpatient care continued to grow, reinforcing the burden on households. Over the past decade, public healthcare spending has increased steadily, with a sharp acceleration during the Covid-19 years and a renewed surge in 2024 linked to contract renewals for health workers.

Regional differences remain pronounced. In 2024, public health spending growth ranged from just 1.1% in Lazio to over 13% in the autonomous province of Trento. Pharmaceutical spending rose in all regions, reaching an incidence of 11.7% of total health expenditure, while spending on intermediate goods and services showed strong volatility, reflecting both pandemic legacies and inflationary pressures.

Private health spending continues its steady climb. After the temporary drop in 2020, out-of-pocket expenditure has grown every year, reaching a record €46.4 billion in 2024. Almost half of this amount is spent on specialist visits and procedures, with dental care accounting for a particularly large share. Veterinary spending also increased sharply, rising by 8.8% to €1.23 billion.

Overall, the report depicts a health system under strain: public funding struggles to keep pace with demand, regional finances are increasingly fragile, and households are paying more out of pocket. The challenge ahead is how to manage a growth in health spending that appears structural, without further widening territorial inequalities or shifting the financial burden onto citizens.