The cost of medical care in Italy are lower because of healthcare workers are paid a fraction of what they are paid in the US. In other European countries they get paid a little more than Italy, but nowhere as much as in the US. Payroll costs are the bulk of healthcare costs (they are 75% of the hospital system where I work). I'm looking at our Payroll for our hospital system, and I see that a Chief Doctor (that is the head doctor of a Department) gets paid from $350k to over $500k per year (base pay). Our Chief of Cardiology is over $700k. A chief in a National Health System Hospital in Italy makes just over 120,000€, that isn't even $150k. That is what my cousin, Chief of Hematology in Emilia Romagna makes. Her equivalent in my hospital, earns almost $500k.
Same is true for Registered Nurses. In our hospitals a Registered Nurse (all with college degrees) makes over $100k (at the start of the career), but a nurse in ICU (Intensive Care Unit) can easily command over $170k and up. Those are base rates (exclusive or overtime or other premium pay). Do you know how much an equivalent nurse, with a University degree earns in Lombardy? They start at about 25,000€ gross a year ($30k) just out of college, then after many years on the job, maybe the surpass 40k€ ($50k).
So, if the labor costs are on average 1/3 of what they are in the US, it's only natural that healthcare costs are much lower. Regarding charging non EU tourists, most Regions (the Italian NHS is managed by each Region autonomously) don't have a mechanism for charging non EU visitors, so you end up paying the same Co-pay that an Italian maybe at the highest income groups (fascia di reddito) would pay. The NHS has 4 income groups (1 to 4) with 4 being over 100K euro per year, and 3 being between 70K and 100k. There are however services, that have no co-pay and are totally free for everybody, namely ER red code (emergency), ER orange code (urgent), ER blue code (deferrable urgency), ER code Green (minor urgency). The only ER service that is subject to copay is the ER white code (not urgent) but it's only 25€ for the visit, plus some additional potential tickets for diagnostic tests (but rarely over 50€).
The Italian law has long required the Regions charge non EU citizens for the full cost of hospitals, but not all Regions are compliant and have implemented anything of that sort, that is why you may never see a bill from a hospital if you happen to go. In 2025 the Region of Tuscany started to implement a new Regional law directive that requires hospitals to charge non EU visitors the cost of the service according to certain fee schedules promulgated by the Regional ASL (Local Health Districts). For example being admitted to Observation in ICU in Tuscany will cost you now 400€ a night. Diagnostic and lab tests will be charged at cost, supposedly at about 150€ to about 300€ depending on the test. An operation will cost up to 2,000€ and so on. Some services, like a code red ER would still be free also to visitors (just the ER visit).
These charges are at cost and do not include mark up (unlike the charges we apply in the US), so they are extremely low compared to what your insurance would pay in the US (my hospital charges (gross charge) about $15,000 for a ICU night and even after the large contractual discounts that insurance companies get, we are still talking thousands, not hundreds $$.
Nevertheless it is a good idea to get travel insurance, because in case of major problems, even those much lower charges in Italy can add up.
