Policies and healthcare

The 'new' doctor's insurance also protects patient health and safety

The insurance obligation is the building block of a broader system of clinical risk management that must guarantee patients' right to fair and timely compensation on the one hand, and professional peace of mind on the other

by Roberto Carlo Rossi *, Giuseppe Deleo **

9 April 2026

4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

The health service in Italia is going through an important transition with regard to the security of the system and the professional stability of those who work on the front line every day. There is much talk of compulsory insurance for doctors-surgeons and dentists. At first sight it might appear to be an additional bureaucratic-administrative hindrance, but in reality it represents a basic guarantee, capable of both protecting healthcare professionals and offering reassurance to patients.

The Origins of the Standard

The regulatory path comes from afar. Even before 2017, the year in which the Gelli-Bianco law was promulgated, the need to build a more orderly framework for healthcare professional liability was evident. As of 16 March 2026, the new regulations (Dm 232/2024) - after seven years of waiting and a two-year adaptation period - came into force and are fully operational, necessitating a rapid and complete adjustment.

This is why the Order of Surgeons and Dentists of Milan has activated a dedicated training on the subject. This is the asynchronous distance learning (Fad) "Regulatory Update on Medical Liability Insurance Policies: Obligation and/or Opportunity", which was created with the aim of shedding light on a regulatory framework that has become increasingly articulated, offering an overview of the general principles and practical indications to help each healthcare professional identify the most suitable policy for his or her work profile.

News in the field

The introduction of certain rules therefore affects both doctors and healthcare facilities, which will have to be compulsorily covered against negligent adverse events. The regulation introduces significant innovations such as the establishment of risk and claims funds for facilities that choose partial self-insurance. It is also established that the standard insurance formula must be the claims made formula, with the precise setting of the maximum limits per event and per year based on the specific profession.

One step forward concerns the definition of retroactivity and ultra-activity, set at ten years, and the regulation of the companies' right of withdrawal, which will be prevented from abandoning the health service when the first unfavourable event occurs, except in extremely special cases.

One of the most relevant aspects will be the possibility of bringing a direct action for damages against the insurance company, without the need to involve the professional in the first place.

High standards in hospital

At the same time, the regulation also imposes high standards within hospitals, regulating the composition of claims assessment committees, which must be characterised by high professionalism and multidisciplinarity. An indissoluble link is then created between the validity of insurance cover and continuous professional training: doctors must have reached the required percentage of three-year training credits - equal to 70% - otherwise the insurance protection will become ineffective, unless there is a regulatory postponement.

This regulatory development is part of a context in which professional liability is one of the most sensitive issues in the health system. In Italia, medico-legal litigation continues to represent one of the main sources of pressure on the system: according to various analyses in recent years, claims have been around 30-35 thousand per year. As far as criminal liability is concerned, it is known that only a relatively limited share - estimated between 2% and 4% - ends in a conviction. Nonetheless, the professional, psychological and organisational burden of criminal (and civil) proceedings remains significant and contributes to the spread of so-called defensive medicine, which according to some estimates can account for several billion euros a year on overall health expenditure.

The burden of litigation

Litigation therefore weighs on professionals like a permanent sword of Damocles, even when the final outcome is not unfavourable. This is why the Gelli-Bianco law represented an important first step in redefining the framework of healthcare liability, introducing fundamental principles such as the centrality of guidelines and the strengthening of clinical risk management systems. However, the application experience of the last few years has shown that some structural issues required further regulatory intervention, particularly on the insurance side.

Risk Management

In this scenario, the insurance obligation must not be interpreted as a mere formal fulfilment, but as a piece of a broader system of clinical risk management and mutual protection between professionals and citizens. A system that must guarantee on the one hand the right of patients to fair and timely compensation and on the other hand the professional serenity of doctors, avoiding that the fear of litigation excessively conditions clinical choices.

Finally, it is advisable to flank these policies with legal protection coverage, since legal costs often represent an unfair and significant cost, even for the professional who emerges from the proceedings without a conviction. In the criminal sphere he will always have to pay his lawyers and in the civil sphere one can only hope that the costs will not be compensated; this last coverage, although not being one of the compulsory ones under the aforementioned rule, is indeed very inexpensive and therefore entirely advisable.

The Paradox

In spite of the progress made, however, open critical issues remain. In fact, the legislation maintains an obvious paradox: the doctor is obliged to take out insurance, but the insurance company is not obliged to accept it. In an already complex insurance market, this imbalance risks leaving precisely the most exposed professionals or those working in areas of high clinical risk uncovered.

On the whole, however, we are faced with a regulatory development that may mark a step forward towards a more modern and less bumpy management of negligent adverse events. In some respects it is a similar path to the one that has brought stability to the third-party motor liability sector over the years: definition of clear rules, minimum standards of coverage, and a better balance between citizen protection and system sustainability.

The course, accredited with ECM and addressed to doctors and dentists registered with the Order, therefore delves into the main application nodes of the legislation - from the guarantee limits to the discipline of company withdrawal, from direct action by the patient to the role of the Claims Evaluation Committees - linking these aspects to clinical risk management and the training obligations of professionals.

* President of the Order of Doctors and Dentists of the Province of Milan (OmceoMi)

** OmceoMi Board Member, Specialist in Legal and Insurance Medicine