Healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service, Sistema sanitario nazionale (SSN), which is organized under the Ministry of Health and is administered on a regional basis.
Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subjected to availability.
Prescription drugs can be acquired only if prescribed by a doctor. If prescribed by the family doctor, they are generally subsidized, requiring only a copay that depends on the medicine type and on the patient income (in many regions all the prescribed drugs are free for the poor). Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be sold in specialized shops (farmacia). In a sample of 13 developed countries Italy was sixth in its population weighted usage of medication in 14 classes in 2009 and fifth in 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use.
Visits by specialist doctors or diagnostic tests are provided by the public hospitals or by conventioned private ones, and if prescribed by the family doctor require only a copay (of the order of $40 for a visit without any diagnostic test) and are free for the poor. Waiting times are usually up to a few months in the big public facilities and up to a few weeks in the small conventioned private facilities, though the referring doctor can shorten the waiting times of the more urgent cases by prioritising them. Patients, however, can opt for the “free market” option, provided by both public and private hospitals, which is paid completely out-of-pocket and has generally much shorter waiting times.