Italian health care is delivered by the National Health Services (NHS), which provides free medical care for all citizens and residents. Patients pay a small contribution to the cost of medical tests and prescriptions, but nothing for hospital admissions or operations. The NHS is financed through taxes at a cost estimated at $72 billion US in 1991, or 5.8 percent of GNP.
A limited proportion of the medical care is delivered outside the NHS, as private practice. Private medical centers with inpatient departments or outpatient clinics may be authorized to deliver health care on behalf of the NHS: this sector involves 700 clinics in the country, with a cost of $4.8 billion US. Twelve percent of these private institutions belong to religious orders.
Physicians are required to register after graduation with the section of the National Order of Physicians of the province where they practice. The professional Order has a role in controlling professional ethics and also functions as a union, although physicians may also belong to one of the other larger unions operating in the country.
The major issue currently affecting the NHS is its cost, which is widely considered too high, especially considering the quality of its performance, which is considered poor, particularly in southern Italy. Although the number of general practitioners is high (63,000 out of over 200,000 registered practitioners), the health care system is generally oriented toward specialist care.
In this century, the Italian educational system has been based on the German model, with the "Master" and his "ex cathedra" lectures at the center. Before 1987, there was no selection for access to medical schools, which caused