by MK
Friuli Venezia Giulia has long been considered one of Italy’s best-performing regions for public healthcare, often cited for its efficiency, professional expertise, and relatively high levels of public investment. But new data released this fall suggest that even this high-functioning system is under growing pressure — and entering a phase where difficult choices may be unavoidable.
Much of the data come from the “Friuli Venezia Giulia Health Report 2025,” published in October by the GIMBE Foundation, an independent research group that monitors the performance of Italy’s public health service. The findings, combined with regional policy plans unveiled in recent weeks, paint a picture of a system that remains resilient but increasingly strained by demographic change, workforce shortages, and uneven reform implementation.
At an end-of-year briefing in Trieste on December 19, regional officials described 2025 as a year of consolidation, laying the groundwork for reforms expected to take fuller shape in 2026. The focus: chronic disease management, community-based care, workforce stability, and the completion of projects financed through the European Union’s post-pandemic recovery funds.
“Our system is a good system, with highly skilled professionals,” said Roberto Di Lenarda, a full professor of odontostomatological diseases at the University of Trieste and former rector, in an interview. “But it is suffering — as everywhere in Italy — from two major problems: rising costs driven by an aging population, and a declining availability of doctors and nurses.”
Funding Strength Meets Structural Strain
According to the GIMBE Friuli Venezia Giulia Health Report 2025, regional healthcare spending reached €2,226 per capita in 2024, exceeding the national average of €2,181. While this reflects a comparatively strong allocation of public funds, it has not shielded the system from rising demand.
In 2024, 8.5 percent of residents — more than 101,000 people — reported postponing or abandoning at least one medical service. Though still below the national average, the figure rose sharply from the previous year, signaling growing access challenges even in one of Italy’s best-funded regions.
Life expectancy at birth stood at 83.8 years, slightly above the national figure — both a measure of healthcare quality and a sign of the demographic pressures reshaping service needs.
A Well-Staffed System — With Key Gaps
On aggregate staffing levels, Friuli Venezia Giulia continues to outperform much of the country. In 2023, the region counted 17.4 healthcare workers per 1,000 residents, far above the national average.
But Professor Di Lenarda cautioned that headline numbers obscure structural weaknesses.
“There is a growing lack of personnel,” he said, particularly among nurses and in frontline services. “This is increasingly making it difficult to keep some hospitals fully operational.”
The physician-to-nurse ratio remains higher than recommended, reflecting a shortage of nursing staff that mirrors national trends. Primary care is under particular strain: more than half of general practitioners exceed recommended patient limits, and the GIMBE report estimates that roughly 150 GPs are missing from the system.
Between 2019 and 2023, the number of general practitioners fell by nearly 13 percent, even as applications to training programs increased — a sign, experts say, that structural constraints persist despite renewed interest in the profession.
Community Care Reforms Advance — Unevenly
Italy’s strategy to shift care away from hospitals and toward community-based services is largely financed through the European Union’s National Recovery and Resilience Plan (PNRR). In Friuli Venezia Giulia, implementation has been mixed.
By mid-2025, nearly all Community Health Centers had activated at least one service, and all Territorial Operations Centers were fully operational. Community Hospitals, however, have lagged behind: only three of the 15 planned facilities were operational, according to the GIMBE report.
Regional authorities say completing these projects will be a top priority in 2026, alongside major investments in hospital infrastructure, including a redevelopment of Trieste’s Cattinara hospital complex.
Professor Di Lenarda argued that the broader challenge is not simply expanding infrastructure, but redefining how resources are used.
“The real necessity today is to decide what is truly necessary and what is not,” he said. “These decisions can be politically difficult, but without them we risk spreading resources too thin.”
Access, Affordability, and Waiting Lists
Despite strong overall performance, affordability remains a growing concern. Di Lenarda pointed to economic barriers that limit access to care.
“For economic reasons, many people cannot go to the doctor as they should — they cannot afford co-payments,” he said. “That makes the problem of waiting lists even harder to solve.”
Waiting times for diagnostic exams and elective surgeries remain a persistent issue, one that regional officials acknowledge cannot be addressed through hospital-centered care alone.
“Hospital care is extremely expensive,” Di Lenarda added. “We need to treat people outside the hospital whenever possible.”
A Regional Case With National Implications
On national benchmarks measuring Essential Levels of Care, Friuli Venezia Giulia ranked ninth in 2023, improving its overall score and performing particularly well in preventive and district services, while hospital care showed greater strain.
Patient mobility remains limited, suggesting continued public confidence in the regional public system. Still, experts caution that rankings alone cannot capture the cumulative stress on services.
“I don’t worry too much about classifications,” Di Lenarda said. “What matters is making the right choices.”
As Italy confronts the challenge of sustaining its universal health system amid demographic aging, fiscal constraints, and workforce shortages, Friuli Venezia Giulia offers a revealing case study: a region that still delivers high-quality care, but one increasingly pushed to confront the limits of even the strongest public models — and the difficult trade-offs required to preserve them.
