The Italian Health Care System: W.H.O. Ranking Versus Public Perception

in World Health Report 2000 ranked the Italian health care system second among 191 countries (France was first) with respect to health status, fairness in financial contribution, and responsiveness to people’s expectations of the health system.1 The U.S. health care system, which spends more per person on health care than any other country, was ranked 37th, last among industrialized countries.1 The WHO report, based on measures developed by public health experts, has been strongly criticized because neither individual experience nor overall public satisfaction with health systems was used in the evaluation;2 nevertheless, it raises crucial questions. What makes the Italian health care system so appealing? What important health outcomes has the Italian health system accomplished? And what perceptions and expectations does the Italian population have of its health system? With this overview of the Italian health care system, we will try to answer these questions. By describing the socioeconomic and political issues of the country, we will illustrate the principles on which the Italian health system is grounded, examine its structure and organization, and define achieved health care outcomes. Finally, focusing on the results of recent surveys aimed at assessing population satisfaction we will discuss the main issues raised by the current Italian health care policy.