Monitoring

Elderly people, up to 40% forgoing care for those who cannot make ends meet

After the pandemic, the figure for the over-65s who do not undergo necessary examinations improves, but the South is still struggling (23%) and throughout Italy poverty and waiting lists cut off four out of ten elderly people from the SSN

by Barbara Gobbi

29 September 2025

3' min read

3' min read

The elderly in Italy number more than 14.5 million, or about a quarter of the country's population, and with their burden of chronic illnesses they have a considerable impact on the National Health Service and on the welfare system in general. But a large portion remains outside of care even today, five full years after the Covid-19 pandemic, which presented this segment of the population with the bitterest bill in terms of both victims and exclusion from the SSN.

In the last two-year period analysed (2023-2024) by the Higher Institute of Health, the data on the withdrawal of visits and examinations are improving but still critical and, above all, extremely heterogeneous in terms of areas of the country - with the South in the dark - and 'crude', in representing a peak of marginalisation precisely among the over-65s who are more fragile due to physical and social conditions and in economic difficulty. For two-thirds of those excluded, the cause of their removal from care is waiting lists, as certified by the Iss with the new data on the 'Silver Steps' surveillance, published in view of the International Day of the Elderly on 1 October.

Portfolio makes a difference

The data show that, after the peaks recorded during the Covid-19 pandemic, the proportion of people over 65 who say they have foregone necessary healthcare services continues to fall: from 23% in 2022-2023 to 18% in 2023-2024. But this overall improvement - warns the Iss - is not evenly distributed.

Economic difficulties continue to be a critical factor: in the two-year period 2023-2024, the renunciation of medical examinations and diagnostic tests is 25% among those who say they make ends meet with some difficulty and reaches 40% among those who say they make ends meet with many difficulties, with no signs of improvement over the previous two years.

"The picture that emerges is that of a population that, despite showing a general improvement compared to the years of the pandemic, continues to experience economic, territorial and social barriers that hinder fair access to health and social-health services," comments Iss president Rocco Bellantone. The refusal to undergo necessary medical examinations or diagnostic tests is a crucial indicator of the health system's ability to guarantee fair and timely access to treatment. It is a phenomenon that not only negatively affects individual health outcomes, but can also lead, in the long run, to increased costs for the entire system'.

More fragile, more excluded

The geographical gradient emerges sharply: renunciation is 13% in the northern regions, rises to 18% in the Centre and 23% among those living in the South and the Islands. The population with more vulnerable health also renounces more: 25% among those with two or more chronic diseases (it is 19% among those without) and 27% among those with sensory problems (the figure is 20% among those without).

First Cause Waiting List

The main reasons for opting out remain the long waiting lists, indicated by two thirds of the respondents who were unable to make the necessary examination or test. This is followed by the difficulty in reaching the facilities (17%) and the high cost of services, which is increasing over the years: from 8% in 2022, to 13% in 2023, to 16% in 2024.

59% go to payment

Since 2023, Silver Steps has also collected information on the use of services: more than half of the respondents used paid services (12% exclusively and 47% sometimes), while only 41% used the public service exclusively.

Access to obstacles

These data go hand in hand with those concerning the accessibility of social and health services: in the two-year period 2023-2024, 32 per cent of the elderly reported difficulties in reaching services such as the local health authority, the family doctor or shops selling basic necessities, with strong inequalities once again to the detriment of those with a lower level of education, greater economic difficulties and residing in southern regions.