| Verified against primary record | |
| Governing instrument | Decreto Legislativo 4 March 2014 number 38[2] |
|---|---|
| Prior authorisation requests (2023) | 161 received, 123 authorised, 38 refused[1] |
| Reimbursement requests (2023) | 265 received, 236 granted, 29 refused[1] |
| Amount reimbursed, authorised care (2023) | EUR 371,626[1] |
| Authorisation cannot be refused | Where the care cannot be provided in Italy within a clinically justifiable time[2] |
| Charging of patients insured elsewhere | The same tariffs as nationals in a comparable clinical situation[2] |
| Parliamentary reporting duty | The Ministry must report to Parliament every two years[2] |
| Independently reported | |
| EU patients using the Directive each year | About 200,000, under 0.05 per cent of EU citizens[3] |
| Bands apply only to the rows beneath them. The 2023 counts are claims made by Italian insured persons for care obtained abroad, not a count of foreign patients treated in Italy, and the Commission notes that requests may be decided in a later year than the one in which they arrive. No official Italian count of foreign patients treated in Italy was located. No typical cost range is given because the decree sets charges by reference to regional tariffs rather than a price list for foreign patients. | |
Medical tourism in Italy is notable less for its volumes, which are modest, than for a provision in the Italian implementing decree that ties the right to treatment abroad directly to domestic waiting times. Authorisation to obtain cross-border care cannot be refused where the care in question cannot be provided in Italy within a clinically justifiable time. Italy reported 161 prior authorisation requests and 265 reimbursement requests for reference year 2023, and it appears in the Commission’s flow analysis as a country whose patients travel outward rather than one that draws patients in.
What Italy reports
For reference year 2023 Italy recorded 161 requests for prior authorisation, of which 123 were authorised and 38 refused, and 265 requests for reimbursement of care not subject to prior authorisation, of which 236 were granted and 29 refused. The amount reimbursed for care subject to prior authorisation was 371,626 euro.[1]
The Commission’s flow analysis names the movements from Italy to France, to Austria and to Germany among the busiest prior authorisation flows in the Union, and places Italy to France among them specifically. Patient mobility under the Directive is predominantly between neighbouring states, and Italy’s pattern is one of outward movement to its northern neighbours.[1]
These are claim counts rather than patient counts, and they describe Italian insured persons obtaining care elsewhere. Nothing in the Directive returns measures foreign patients treated in Italy, and no Italian statistic doing so was located for this article.[1]
The waiting-time provision
Italy transposed the Directive by Decreto Legislativo of 4 March 2014 number 38, published in the official gazette of 21 March 2014, which also implements the related directive on prescriptions.[2]
Prior authorisation applies in limited cases, such as care requiring a hospital stay of at least one night or the use of highly specialised equipment. Applications go to the local health authority of the patient’s residence, supported by medical certification. The authority must decide within 30 days, halved where the case is urgent, and a refusal can be appealed to its director general within 15 days, who must in turn decide within 15 days.[2]
The decree then removes the discretion to refuse in one defined circumstance: authorisation cannot be refused if the care cannot be provided in Italy within a clinically justifiable time. This converts a domestic capacity failure into an individual entitlement to treatment in another member state, and it is the clearest statutory link between waiting lists and cross-border travel among the European instruments examined for this site.[2]
Reimbursement is confined to services covered by the national essential levels of care, paid at regional tariffs, net of co-payments, and never above the actual cost incurred. Claims are due within 60 days of treatment, subject to exceptions, and the local health authority must pay within 60 days of receiving the claim.[2]
The underlying Directive permits prior authorisation only for care subject to planning requirements that involves an overnight stay or highly specialised and cost-intensive infrastructure, for treatments carrying a particular risk, and for providers raising serious quality or safety concerns, and caps reimbursement at the level of costs the home state would have assumed without exceeding the actual cost received.[5]
Patients arriving in Italy
Patients from other member states may not be discriminated against on grounds of nationality. Providers must apply the same tariffs as they would for nationals in a comparable clinical situation, or, where no comparable price exists, an objective and non-discriminatory price.[2]
The national contact point is established at the Ministry of Health, publicised through the Ministry’s portal, and draws on the national health information system for provider information. Regions may establish their own regional contact points alongside it.[2]
Monitoring and reporting
The decree does not impose an explicit duty to count cross-border patient flows. It does require the Ministry to promote a monitoring system for care networks covering quality and safety standards, volumes and outcomes, using a revised hospital discharge data flow, which is the record type that would in principle allow non-resident patients to be identified.[2]
Regions must monitor effects and report critical issues to the Ministry of Health and the Ministry of Economy, the Ministry must provide information to the European Commission, and it must report to Parliament every two years. No such parliamentary report was located for this article.[2]
Eurostat separately maintains a collection of hospital discharges of non-residents, with tables for in-patients, day cases, bed days and average length of stay, reporting country of residence for non-resident patients where member states can supply it. Individual cell values for Italy were not retrievable for this article.[4]
For context, the European Court of Auditors estimated that about 200,000 patients a year use the Directive across the Union, fewer than 0.05 per cent of EU citizens, with spending amounting to roughly 0.004 per cent of the Union’s healthcare budget, and prior authorisation applying in around 1 per cent of cases.[3]
Limits of the evidence
The Italian figures are small enough that year-to-year movements should not be read as trends, and because decisions can fall in a later year than the request, the authorised and refused counts do not reconcile exactly with requests received. The decree was read from a copy published by a professional medical body rather than from the official gazette, with the decree number, date and gazette reference confirmed from that copy, and the provisions summarised may not reflect later amendments. No official count of foreign patients treated in Italy, and no figure for privately funded treatment of foreign patients, was located.
See also
- Medical travel and waiting lists, the link Italian law makes explicit
- Medical tourism in Austria, one of the destinations Italian patients travel to
- Medical tourism in France, another destination named in the same flows
- Government-funded treatment abroad, the category these authorised cases fall into
- Hospital discharge data in medical tourism, the record type Italy’s monitoring system relies on
References
- European Commission, Directorate-General for Health and Food Safety. Data on cross-border patient healthcare following Directive 2011/24/EU, reference year 2023. 15 May 2025. Verified against primary record: the report was opened and the Italian rows for prior authorisation and reimbursement and the amount reimbursed, the naming of the Italy to France, Austria and Germany flows, and the caveat that requests may be decided in a later year were read directly. Retrieved 23 October 2026.
- Italian Republic. Decreto Legislativo 4 marzo 2014, n. 38. Gazzetta Ufficiale number 67, 21 March 2014. Verified against primary record: the decree was opened and the prior authorisation grounds, the local health authority procedure and 30-day and 15-day limits, the rule that authorisation cannot be refused where care is unavailable in Italy within a clinically justifiable time, the reimbursement basis and the 60-day limits, the non-discrimination and tariff rules for patients insured elsewhere, the national contact point arrangements, the care network monitoring system using the revised discharge data flow, and the regional and parliamentary reporting duties were read directly. This copy is published by a professional medical body. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the annual patient estimate, the share of citizens, the share of healthcare spending and the share of cases requiring prior authorisation were read. Retrieved 23 October 2026.
- Eurostat. Hospital discharges and length of stay for inpatient and curative care (hlth_hosd), reference metadata. Last updated 15 December 2025. Verified against primary record: the metadata page was opened and the non-resident definition, the statement that country of residence is reported, and the list of non-resident tables were read. Retrieved 23 October 2026.
- European Parliament and Council. Directive 2011/24/EU, Chapter III, Articles 7 and 8. 9 March 2011. Verified against primary record: the chapter text was opened and the reimbursement rule in Article 7 and the three permitted grounds for prior authorisation in Article 8(2) were read. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. The Italian claim counts describe Italian patients obtaining care abroad and are not presented as a measure of foreign patients treated in Italy, for which no official figure was located. The decree was read from a copy published by a professional medical body because an official consolidated text could not be opened, and the identifying details were confirmed from that copy. No parliamentary report under the decree’s two-yearly duty was located, and no figure has been estimated.