Italians Spent a Record €5.15 Billion on Healthcare Outside Their Region

The Italian healthcare system recorded a historic high in internal "health tourism" in 2023. According to the latest report by the independent Gimbe Foundation, citizens spent €5.15 billion on medical services outside their region of registration. This amount, the highest since such statistics have been kept, is a telling indicator of chronic and deepening inequalities in access to care across the country. „„È un record storico che mostra quanto la qualità dell'assistenza sanitaria cambi a seconda di dove si vive in Italia.”” — Nino Cartabellotta, president of the Gimbe Foundation The problem of varying healthcare quality between Italian regions has its roots in the 1990s reform that decentralized the system, transferring responsibility for healthcare to regional authorities. In theory, this was meant to bring services closer to citizens; in practice, it created twenty different systems with very diverse financial, managerial, and quality capabilities, resulting in an internal patient market. Analysis of Gimbe Foundation data reveals a clear and concerning geographical divide. Northern and northeastern regions, equipped with networks of modern hospitals, specialized centers, and relatively shorter waiting times, have become strong magnets for patients from across the country. Leading the way is Emilia-Romagna, which recorded the highest positive balance per capita, confirming its position as a leader in system efficiency. Lombardy and Veneto are also regions with significant positive balances. On the other hand, southern regions, especially Campania, Sicily, Calabria, and Apulia, are experiencing the most dramatic outflow of patients and capital. Their healthcare systems, already struggling with managerial problems and underfunding, are losing billions of euros that flow into the coffers of hospitals in the north. This process creates a vicious cycle: the flight of patients means an outflow of funds, which limits investment in local infrastructure and staff, which in turn lowers service quality and encourages more residents to seek help elsewhere. 5,15 mld € — Record sum spent on treatment outside the region in 2023. Detailed regional reports, published on March 4, 2026, provide telling examples of the local dimension of this phenomenon. Liguria, a popular tourist region, recorded a negative balance of over €74 million. In the small Aosta Valley, the deficit amounted to €12.8 million. In the Marche region, authorities had to allocate €54.7 million to cover the costs of so-called passive mobility, i.e., reimbursing treatment for its residents in other parts of Italy. The report also noted cases of some improvement or less severe losses. Umbria recorded only a "moderate" negative balance, and Basilicata saw a reduction in its deficit of €2.9 million compared to the previous period, which may indicate some local corrective actions. However, these isolated cases do not change the overall, alarming trend. Mass "health migration" is not solely an economic problem but also a social and constitutional one, challenging the principle of equal access to healthcare for all citizens, regardless of place of residence, guaranteed by the Italian constitution. The public debate, sparked by the report, is again focusing on the search for systemic solutions that could stem this outflow, such as greater structural investment in the south, staff support, or greater coordination between regions.

Perspektywy mediów: Liberal and center-left media emphasize the healthcare crisis in the south as an effect of chronic underfunding and poor management, demanding state intervention. Conservative and center-right media point to the inefficiency of spending and management in regions governed by the left, arguing for greater responsibility of local authorities.