The president of Istat reiterated the point to Parliament as it works on the Budget Law: waiting lists are too long and the only alternative is private care.

Almost one in ten Italians is going without healthcare. The figure that Istat president Francesco Maria Chelli placed before the Senate Budget Committee a few days ago — during expert hearings ahead of amendments to next year's Budget Law — is one of the most striking, not least because it translates directly into human beings, unlike data that are "merely" statistical or economic in nature.

And yet it was a figure already known for some months, specifically since last May, when Istat had included it in its annual report on the state of the country, spelling out in black and white that in 2024, 9.9 per cent of the population — roughly 6 million people — reported having foregone specialist visits or tests despite needing them.

A figure that has risen sharply from 7.5 per cent in 2023 and 6.3 per cent in 2019, before the pandemic — people going without care. It is a portrait of a country in which barriers to healthcare access — financial, organisational and geographical — are widening, with a direct impact on people's health. How has the political world responded? By allocating 7.7 billion euros to the National Health Service (Ssn) in the Budget Law. A lot, according to those who think in absolute terms (the Ssn has never been so generously funded, set to reach 145 billion by 2028); too little, according to those who think in relative terms: in that same 2028, those 145 billion will amount to 5.9 per cent of gross domestic product — also a record, but this time a negative one. The latter criterion is generally considered the more meaningful one, as it gives a true sense of how far the Ssn can actually be funded.

Returning to why one in ten Italians foregoes care, there are two main reasons. The first, and increasingly significant, is waiting lists: 6.8 per cent of the population cannot obtain visits or tests within a reasonable timeframe and gives up on the service — a figure that has risen by 4 percentage points since 2019 and by 2.3 points in a single year. The second is cost: 5.3 per cent report financial difficulties severe enough to prevent them from covering healthcare expenses. At the same time, recourse to the private sector is growing: in 2024, 23.9 per cent of people paid entirely out of pocket for their last specialist visit, compared with 19.9 per cent in 2023 — a signal of a system that is struggling to guarantee timely, accessible care.

🔵 "In 2024, 9.9% of people reported having foregone medical care due to problems related to waiting lists, financial difficulties or the inconvenience of healthcare facilities." These were the words of Istat president Francesco Maria Chelli, speaking at a hearing on the Budget Law. pic.twitter.com/dfdQMnfaar

The phenomenon does not affect everyone equally. Women forgo care more than men — 11.4 per cent versus 8.3 per cent — yet another area in which the gender gap persists in our country. The divide is most stark among those aged 25 to 34: 12.5 per cent of young women go without care, nearly double the rate of their male peers (7.1 per cent). Among those aged 45 to 54 — the most affected group overall (13.4 per cent) — financial and organisational barriers carry roughly equal weight; from age 55 onwards, booking difficulties become the dominant factor. Going without care is now widespread across the country: 9.2 per cent in the North, 10.7 per cent in the Centre, 10.3 per cent in the Mezzogiorno. What is new is the worsening situation in the North, which is narrowing the historic gap with the South: in 2019, only 5 in 100 northern residents went without care, compared with 7.5 per cent in the Mezzogiorno. The reasons are also shifting: in the Centre-North, waiting lists are the dominant factor, while in the Mezzogiorno, financial difficulties and waiting times weigh equally.

Education level continues to act as a protective factor: among adults with a low level of education, 7.7 per cent forgo care for financial reasons; among the more highly educated, the share falls to 5.7 per cent. But the gap widens with age: beyond 65, less educated people forgo care for financial reasons more than three times as often as university graduates. When the reason is the waiting list, the difference is most pronounced among older people.

In short, the phenomenon of foregone care — which grew in the wake of the pandemic — is today cross-cutting, spanning all social groups, including those that previously faced fewer difficulties. For Istat, going without care represents a form of healthcare exclusion that "has a direct impact on individual and collective health." Delayed diagnoses, worsening of chronic conditions, knock-on effects on employment and income, and increased use of emergency departments are among the most common consequences. And the phenomenon is unfolding at a time when, even as life expectancy rises, the years lived in good health are declining — especially among women — and recourse to private solutions is growing more out of necessity than out of choice.