Italy’s private healthcare sector grew by 3.7% in 2023, with a significant surge in the growth rate of entities managing nursing homes (RSA), according to a report by Mediobanca’s research area. The data indicates a shifting landscape in Italian health services, where private providers are expanding their footprint in long-term care and rehabilitation to meet the demands of an aging population.
The Mediobanca analysis highlights that while the overall private health sector maintains a steady upward trajectory, the acceleration in RSA (Residenze Sanitarie Assistite) management is nearly double the average growth of the broader sector. This trend reflects a strategic pivot toward elderly care and chronic disease management, which are becoming primary drivers of revenue and demand within the Italian healthcare market.
For global health investors and policymakers, these figures underscore a broader European trend: the increasing reliance on private capital to fill gaps in state-funded long-term care. In Italy, where the Ministero della Salute manages the national health framework, the integration of private RSA providers is essential for maintaining bed capacity as the demographic shift increases the prevalence of non-communicable diseases.
Private Healthcare Growth and the RSA Surge
The 3.7% expansion of the private health sector is not uniform across all specialties. Mediobanca reports that the most aggressive growth is concentrated in the management of nursing homes and rehabilitation centers. This “doubling” of growth relative to the general sector suggests that the market for residential care is expanding faster than outpatient clinics or specialized diagnostic centers.
This growth is driven by a combination of increased demand for long-term care and a consolidation of the market. Larger healthcare groups are acquiring smaller, fragmented facilities to achieve economies of scale. According to the Mediobanca report, this consolidation allows for more standardized care protocols and improved financial stability, though it also concentrates market power among a few large operators.
The focus on rehabilitation is particularly notable. As surgical procedures become less invasive and recovery times shorten, the demand for post-acute care—bridging the gap between a hospital stay and returning home—has created a lucrative niche for private providers. This “intermediate care” model reduces the burden on public hospitals by transferring recovering patients to private rehabilitation facilities.
Profitability Trends in 2024
Looking into 2024, Mediobanca signals that profitability within the sector is undergoing a transition. While revenue has increased, the cost of labor and energy has pressured margins. The report indicates that profitability is currently being influenced by the ability of providers to renegotiate contracts with regional health authorities (ASL) and adjust pricing for private-pay patients.
The financial health of these providers depends heavily on “convenzioni,” or agreements with the public health system. In Italy, a significant portion of RSA funding comes from public reimbursement. Any delay or reduction in these payments directly impacts the bottom line of private operators. Consequently, the 2024 outlook focuses on “operational efficiency”—reducing overhead while maintaining the quality of care required by law.
Investment in digitalization is also appearing as a key factor in maintaining profitability. Providers implementing electronic health records (EHR) and remote monitoring tools are reporting better resource allocation and a reduction in administrative waste, which helps offset the rising cost of nursing staff.
Impact on the Italian Healthcare System
The rise of private RSA management has direct implications for the Italian National Institute of Statistics (ISTAT) demographic projections. With one of the oldest populations in the world, Italy faces a “silver tsunami” that the public sector cannot fund alone. The growth of private providers ensures that there are enough beds available, but it raises questions about the equity of access for those who cannot afford private top-ups.
The relationship between the public and private sectors in Italy is characterized by “accreditamento” (accreditation). Private facilities that meet state standards can treat patients funded by the National Health Service (SSN). The Mediobanca data suggests that the private sector is not replacing the public system but is instead becoming an indispensable partner in the delivery of long-term care.
Critics of this trend often point to the risk of “cherry-picking,” where private providers focus on less complex, more profitable patients, leaving the most expensive and difficult cases to public hospitals. However, the growth in specialized rehabilitation centers suggests that private firms are moving toward more complex clinical offerings to capture higher reimbursement rates.
Strategic Outlook for Health Operators
The current trajectory suggests that the “healthcare real estate” aspect of the business is becoming as important as the clinical delivery. Companies that own the physical assets of the RSAs are seeing significant valuation increases, leading to a trend of “sale-and-leaseback” agreements to unlock capital for further expansion.
Furthermore, the integration of “integrated care” models—where a single provider manages the patient from the initial diagnosis through rehabilitation and into long-term residential care—is becoming the gold standard for growth. This vertical integration reduces patient leakage and ensures a steady stream of revenue across different stages of the care continuum.
As Italy continues to implement the National Recovery and Resilience Plan (PNRR), which allocates billions of euros toward “community health” and home-based care, private providers are expected to pivot again. The next phase of growth will likely move beyond the walls of the RSA and into “domiciliarità” (home care), utilizing telemedicine to reach patients in their own residences.
The next major data checkpoint will be the release of the year-end financial summaries for the top Italian healthcare groups, which will confirm if the 2024 profitability trends aligned with Mediobanca’s current projections. These filings will reveal the actual impact of labor cost inflation on the 3.7% growth trend.
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