Every year, millions of Italians receive prescriptions for medical visits and diagnostic tests through the Servizio Sanitario Nazionale or National Health Service (SSN), only to find that long waiting lists push more than two out of every three prescriptions out of the public health system. Patients either pay out of pocket for private care or, worse, forgo treatment altogether. That amounts to 24.5 million services over six months, or roughly 50 million a year.

The full extent of the damage caused by long waits for medical care emerges from a table that Italy’s National Agency for Regional Health Services (AGENAS) did not highlight in the quarterly report on waiting periods it presented yesterday. The figures are startling — and cover only the 14 most common initial specialist visits and 22 most frequently requested diagnostic tests monitored by the agency.

According to the data, an average of 659 prescriptions for these visits and tests are issued through the SSN for every 1,000 residents nationwide. Just over half results in the patient being taken into the system and provided with an appointment, even if the wait is endless. Only 36.5% lead to a service that is actually provided by the public system.

There are wide regional disparities. In Lazio, just 21.9% of prescriptions result in a visit or test, compared with 51.6% in the autonomous province of Bolzano. Lombardy stands at 35%, while Campania reaches 43.3%. Piedmont records 37.8%, but the region’s Healthcare Commissioner, Federico Riboldi, is keen to point out that “while we rank near the bottom for initial appointments, we rank first for other services, with 279.7 services delivered out of 426 prescriptions per 1,000 residents.”

The figures alone cannot explain why so many people queue at their family doctor’s office for a prescription that would give them access to free care, only to give up before receiving it.

This is all the more striking because the latest AGENAS report, based on data through the end of September, appears to show a slight improvement in waiting periods. The share of initial specialist appointments booked within the maximum waiting periods set by law rose from 76.9% to 78.6%. Diagnostic tests reached 85%, up from 83.3% in the corresponding monitoring period in 2025. Yet in absolute terms, that still means roughly 4 million services — no small number — are being provided beyond the guaranteed time limits.

There is a catch: these figures are self-reported by the regions, while the data on services that disappear from the public system come from Italy’s health insurance card database, which records the actual pattern of services delivered.

That does not mean the regions are submitting “false” figures. But the numbers often conceal practices that make waiting periods appear to comply with the legal limits when they do not. The most common tactic is to pressure doctors to mark prescriptions with the letter P, for programmabile, or “schedulable.” This category allows a service to be provided within 120 days — a potentially reasonable interval for a follow-up, but not for a first specialist visit or an initial diagnostic assessment.

Health care experts estimate that schedulable services should account for no more than 7% of prescriptions for initial appointments. Yet AGENAS data show that they make up nearly one in three — 34.9%, to be exact.

The national average, however, shows sharp regional differences. Tuscany, at 6.1%, Piedmont, at 8.8%, and Emilia-Romagna, at 9.3%, remain within a more or less acceptable range. In six other regions, more than half of these services can legally be delayed for as long as four months: Lombardy (52.5%), Lazio (52.9%), Calabria (66%), Molise (73.7%), Campania (76.2%) and Basilicata (85.4%).

Not coincidentally, Basilicata also boasts the highest rate of services delivered within the prescribed time limits, meeting the deadline for 99% of initial specialist visits.

Another persistent problem is the complete closure of booking schedules, an illegal practice that has never entirely disappeared. Then there is what is known as galleggiamento, or “floating”: a booking center tells patients there are no appointments available, but promises to call them back later with a date — without saying when. The appointment is then recorded as falling within the legal time limit, even when the actual wait exceeds it.

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