Italy: Government to charge foreigners to use health service

Rome: Italy’s Economy Ministry has announced that it intends to charge foreigners from outside the EU who live in Italy a fee to use the public health service. The costs are expected to amount to €2,000 per year.

The charges, will be adopted in the 2024 budget. There will also be an unspecified discount for those who possess legal residency papers, as well as foreign students and au pairs, the agency added.

According to the ministry’s online statement, the budget covers the period 2024-2026. Finance and Economy Minister Giancarlo Giorgetti said that the new budget was “in line with a prudent approach, that is responsible and realistic.”

The minister stated that his government had been concentrating on the “extra deficit, and wanted to give some kind of relief to the medium to lower earners and their dependants.” Giorgetti added that Italy had been “feeling the weight of the heightened interest on the public debt,” and that some things were not negotiable at the moment, like the price of energy.

In order to achieve their aims, one of the measures included in the budget, explained Giorgetti, are changes to health provision. As well as the charges, the government intends to add funding to the health service “equivalent to €3 billion per year in 2024 … this will add to the money already set aside to support the Sicilian region and as part of the National Plan for Recovery and Resilience (PNRR) as well as €4.2 billion from 2026.”

Bonuses will be offered to health care providers who manage to reduce the waiting list time. And resources will also be allocated in the year 2025 to help regional health providers appoint more employees.

However, although Italy provides free public healthcare and extends this not only to Italian nationals, but also foreign workers, job seekers and asylum seekers, as well as unaccompanied minors, there are some categories of foreigners who already have to pay certain costs. For instance, diplomats and foreign students can use the Italian health service but for a variable fee, dependent on their annual income.

The student charges are capped at €150 per year but for higher earners, fees can reach as much as €2,800 per year.

A spokesperson from Italy’s biggest trade union CGIL, Giordana Pallone, told the Italian news agency Adnkronos that depending on what the details turned out to be, the reform could fall foul of the Italian constitution which guarantees free medical care for the poor.

“We’ll have to wait to see how the law is written, because as it is reported today, it has no value or basis compared to the system and regulations that we have,” explained Pallone. Writing in the financial news portal Qui Finanza, one journalist said that the government’s proposals had “kicked up some dust.”

During the press conference, according to Qui Finanza, Giorgetti explained that the charges would not apply to those who are registered in Italy and are working, unaccompanied minors and those who are waiting for their residence permits to arrive.

The new changes will follow in the footsteps of provisions made in a 1998 law, reports Qui Finanza. Here, the law stated that foreigners who are registered in Italy and are there for longer than three months are not obliged to sign up for the national health service, but they are obliged to make sure they are covered with some kind of medical insurance, which means effectively they need private health insurance or they sign up for the national health service and are charged a fee.

Even with the discounts the new costs could rise by around 470% for some people, from say €149 per year for foreign students resident in Italy to around €700 per year, writes Qui Finanza. People working as au pairs could be asked to start paying €1,200 per year instead of the current €219, which amounts to an increase of 547% stated the financial news portal.

Italy’s Order of Doctors (Ordine dei medici) released a statement following the news, noting that “Article 32 of the constitution protects the rights of the individual and the collective. The article underlines that medical help must be offered for free to those too poor to pay for it. If non-EU foreigners do not have any money, then they must be helped free of charge. Here we are not talking about citizens but individuals. So in our opinion, the right to free health care is guaranteed over and above whether anyone can pay for it.”

Although these charges are not directly related to migrants and asylum seekers, and cover all foreigners in the country, critics of the proposals see the charges as another way that the right-wing government is attempting to make it harder to be in Italy without the correct papers.

Last month, for instance, the government proposed charging migrants around €5,000 if they wanted to avoid detention while their request for protection was being processed.

A study by the Society of Medical Sciences (SISMED) in Italy in 2022 found that although health provision is provided free in Italy — since 1982 — Italians have been paying for certain services via a ticket system. You can see a general practitioner for free but if you have a specialized medical visit, you will need to pay. Diagnostic tests and laboratory tests often come at a cost, as well as non-urgent care and non-emergency care that do not need a recovery period in hospital. If you want to visit a thermal spa, you will also need to pay.

However, some patients can get some of these treatments without paying: If you have a chronic or a rare disease, if you have diabetes, cardiopathy, are disabled, have a fast-growing tumor, are pregnant or if you want to do an HIV test.

Despite these exceptions, the national daily paper Corriere della Sera reported at the beginning of 2023 that some Italian families were forgoing medical care because of fears of the costs involved.