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Disability and care: the Mediterranean gap between co-payments, waiting lists and a flight to the private sector

In Greece a 15% co-payment for treatment arrives, in Spain and Italy limited coverage and record waiting lists push families towards the private sector, with costs of up to one thousand euros per month

by Silvia Martelli (Sole 24 Ore), Lena Kyriakidi (Efsyn ) and Ana Somavilla (El Confidencial, Spain)

15 August 2025

4' min read

Access to care for people with disabilities remains, in Europe, a critical indicator of social and economic inequality. Greece, Spain and Italy - three Mediterranean countries with universalistic public healthcare systems but now under severe pressure - are facing similar challenges: budget constraints, waiting lists, partial coverage and increasing recourse to the private sector.

Greece: from 'zero co-payment' to 15% co-payment

The Greek case is emblematic of how a regulatory change can translate into a direct and immediate cost for frail citizens. In 2024, the regulation on health benefits was revised by introducing a 15% co-payment for outpatients in public or private rehabilitation and recovery centres. In the past, therapies for people with motor disabilities or chronic diseases were fully paid for by the state.

Today, for a disabled adult, one month of treatment can weigh heavily on the family budget: the disability pension - 338 euros per month for a disability of over 67%, 570 euros over 80% - often does not cover the entire course of treatment. The economic problem is compounded by the geographical one: specialised centres are concentrated in large cities, leaving vast peripheral areas with minimal supply and forcing families to make costly journeys.

Spain: free public care, but not always sufficient

In Spain, the national health system (SNS) usually covers the costs of rehabilitation in public centres. However, the provision depends on the autonomous communities, and not all of them guarantee the same number of sessions or access times. For outpatient therapies such as physiotherapy, speech therapy or occupational therapy, the public covers on average between 4 and 12 sessions per month, which can only be extended if medically justified.

Long waiting lists - over 4.5 million people at the end of 2023 waiting for surgery or a first visit - push many families towards the private sector. Here, costs are significant: a month of intensive physiotherapy (2-3 times a week) varies between 400 and 800 euros for adults, and between 500 and 1,000 euros for children; a single speech therapy session can cost up to 60 euros. Access to specialist facilities outside urban centres remains limited, and in many rural areas it is necessary to travel to other provinces or regions.

The result is an increasing use of private policies - which in 2023 covered 25.8% of the population, with peaks of 40.5% in Madrid - also favoured by tax incentives to companies.

Italy: fragmented coverage and regional differences

In our country, healthcare for people with disabilities is guaranteed by the National Health Service, but the availability and quantity of services varies markedly from region to region. Physiotherapy or speech therapy sessions in the public system are often subject to monthly limits and waiting lists that in some areas exceed six months. The consequence is that many families resort to private centres, where costs can range between EUR 30 and EUR 70 per session, with higher peaks for specialist therapies.

Accompanying or disability allowances - on average between EUR 300 and EUR 500 per month - rarely cover the full cost of a rehabilitation cycle. The problem of territorial equity is accentuated by health decentralisation: some regions have capillary rehabilitation networks and agreements with the private sector, others rely almost exclusively on central hospital facilities.

Italy, like Spain and Greece, is also seeing growth in the private health insurance sector, especially in corporate form, as a response to the public sector's reduced ability to guarantee timeliness and continuity of care.

The push towards the private

In the three countries, the erosion of the public system's capacity to meet the demand for specialised care has a domino effect: long waiting times lead citizens to turn to the private sector; the economic burden falls on families; those who cannot afford it reduce or discontinue treatment, leading to a deterioration in their quality of life and, in the long term, to increased social and health care costs.

Privatisation is evident in Spain, where many autonomous communities enter into agreements with private clinics to reduce waiting lists, and in Italy, where accredited services absorb an increasing share of the regional budget. In Greece, the move from zero co-payment to copayment has paved the way for greater cost-sharing, reducing the margin of universality.

Strategies and Critical Issues

Strategies to fight inequalities exist, but are often insufficient: in Spain, the creation of the State Public Health Agency is seen as a step to coordinate policies at the national level; in Italy, some PNRR projects aim at strengthening territorial healthcare; in Greece, economic support measures for low-income families with disabled children have been announced. However, in all three countries, the crux remains the real coverage of costs and the territorial availability of services.

The challenge is not only health, but also economic and political: ensuring equal access to rehabilitation care for people with disabilities means reducing social inequality and preventing a widening gap between those who can pay and those who cannot. For Greece, Spain and Italy, the real question is whether the universality enshrined on paper will be able to withstand budgetary pressures and the temptations of ever-increasing privatisation.

*This article is part of the European collaborative journalism project "Pulse".