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Italy’s spending on permanent hospital staff fell by €28 billion over the past 11 years and doubled for freelance medical staff in 2023 alone, Nino Cartabellotta, president of the Gimbe Foundation, recently told parliament.
News Based on facts, either observed and verified directly by the reporter, or reported and verified from knowledgeable sources.
(Photo by Hristo Rusev/Getty Images)
Based on facts, either observed and verified directly by the reporter, or reported and verified from knowledgeable sources.
Languages: Spanish
ROME – Italy’s public health system has become increasingly reliant on temporary, freelance medical professionals, but what was originally intended as a quick fix has trapped the country in a costly spiral, exacerbating the very problems it was intended to solve.
Between January and August 2023, the government spent €476.4 million on freelance medical staff – double the amount spent the previous year.
Although the figures seem to be going down, spending on freelance doctors and nurses reached nearly half a billion euros in 2024, according to the National Anti-Corruption Authority (ANAC).
A key driver of this trend is the significant pay gap between permanent healthcare workers and freelancers.
National nurses’ union Nursing Up told Euractiv that a permanently employed nurse earns around €1,500 per month after taxes.
By comparison, a freelance nurse can earn the same yearly amount as a staffed nurse in just three months working regular eight-hour shifts without overtime – a lucrative but vicious circle as permanent health workers leave their lower-paid, secure positions to go freelance.
Patient care also at risk
But this continued reliance on freelance workers also raises serious concerns about the quality of patient care.
As part of 1,525 inspections carried out between November and December 2023, the Italian Health and Safety Authority (Nas) found doctors working as obstetricians without proper training in caesarean sections, emergency room doctors without emergency medicine qualifications, medical staff already employed elsewhere secretly working double shifts, and even doctors over 70 who by law should no longer be practising.
Before the Italian parliament, Nino Cartabellotta, president of the Gimbe Foundation, described the situation as an “unprecedented healthcare staffing crisis.”
In his address to lawmakers, he said Italy’s spending on permanent hospital staff fell by €28 billion over the past 11 years and doubled for freelance medical staff in 2023 alone.
Government acknowledges crisis
The severity of the crisis has already been acknowledged by Health Minister Orazio Schillaci, who has introduced several measures aimed at curbing the use of freelance medical staff.
These include restricting the use of freelance medical staff to genuine emergencies, setting maximum hourly rates for freelance doctors (€85 for urgent care and €75 for other medical services) and nurses (€28 and €25), and requiring freelance staff to take out their own professional indemnity insurance.
Schillaci also pledged to raise salaries for permanent health workers and increase the number of staff in public hospitals to make permanent positions more attractive and sustainable.
Not enough?
But critics argue that the reforms fall short of addressing the systemic causes of the crisis.
Nursing Up President Antonio De Palma acknowledged the latest guidelines as a step forward but warned that they still fall far short of addressing the core of the problem and called for structural recruitment plans.
For him, Italy continues to rely on temporary fixes to fill chronic staffing gaps without investing in a long-term strategy to strengthen its public health workforce.
“In the first nine months of 2024 alone, over 20,000 nurses quit—many of them opting for freelance work,” he said.
He described the situation as a “short circuit” in which public hospitals are actively contributing to the breakdown of the system. “Instead of valuing the professionals they already have, they are tearing the system apart,” he added.
“We are receiving more and more reports of hospitals rehiring former staff as freelancers,” he said, adding that this disparity is fueling a dangerous cycle that is bad for the entire healthcare system.
“Not only are freelance professionals working without guarantees or protections, but patients are also being exposed to increasingly unstable and precarious care,” he concluded.
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Money heist: Why Italy’s health-care system is on life support – Euractiv
