Fides CF | Insight on Italy’s NHS

Italy’s National Health Service (SSN) is experiencing the most severe structural crisis in its forty-five-year history. Data from the 8th GIMBE Report on the SSN, presented to the Italian Chamber of Deputies on 8 October 2025, paint a picture of chronic underfunding, widening regional disparities and the progressive erosion of the founding principles of Italy’s universal healthcare system.

Italy’s public healthcare spending stands at 6.3% of GDP in 2024 — well below both the OECD average (7.1%) and the European average (6.9%) — with a per-capita shortfall of $854 relative to the European OECD average, equivalent to an aggregate gap of €42.9 billion per year.1 The National Health Requirement (FSN) is set at €136.5 billion for 2025, but the trajectory mapped by the 2025 Budget Law implies further relative contraction: the FSN-to-GDP ratio will fall from 6.1% to 5.8% by 2028, generating a cumulative gap between projected health expenditure and the actual FSN of nearly €40 billion over the 2025–2028 period.2

The consequences for citizens are tangible. In 2024, more than 5.84 million people (9.9%) gave up healthcare services: 3.1 million for economic reasons and 4 million due to excessive waiting times — a figure up 51% from 2023.3 Out-of-pocket spending reached €41.3 billion in 2024, far exceeding the WHO’s recommended 15% threshold, signaling a de facto privatization of healthcare expenditure in Italy.

Against this backdrop of public system failure, a process of privatization of healthcare production is creating structural opportunities for private capital. 58% of the 29,386 healthcare facilities registered in 2023 are privately accredited; out-of-pocket spending on non-accredited providers (the so-called “pure private” segment) grew 137% between 2016 and 2023, from €3.05 billion to €7.23 billion; international private equity funds are increasingly active in acquisitions, drawn by demographic ageing, the rise of chronic disease and a highly fragmented supply landscape.4

This report analyses the state of the SSN drawing on the GIMBE 2025 Report — the most comprehensive and independent source on the subject — and translates its findings into M&A implications for the Italian healthcare sector: from accredited private providers to elderly residential care (RSA) facilities, from diagnostic centres to smart clinics, through to supplementary health funds. The core thesis is that the SSN’s crisis, far from being merely an institutional problem, constitutes a structural catalyst for consolidation, acquisition and growth transactions in the Italian private healthcare mid-market.

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