A legislative proposal in the Lazio Regional Council aims to grant homeless individuals the right to a designated primary care physician, removing the residential address requirement that currently restricts access to the Italian National Health Service (SSN). The initiative, introduced by the Democratic Party (Pd) regional group and signed by group leader Pierfrancesco Majorino, seeks to decouple healthcare registration from formal housing status to ensure preventative medical care for the city’s most vulnerable residents.
Under current Italian administrative frameworks, the assignment of a medico di base (general practitioner) or a pediatrician of choice is typically tied to a citizen’s residenza, or legal registered residence. Because individuals experiencing homelessness often lack a fixed address, they are frequently excluded from the primary care system, leaving them dependent on emergency rooms or charitable clinics for basic health needs.
The proposal argues that the lack of a primary physician leads to a systemic failure in managing chronic conditions and preventative screenings. According to the World Health Organization, housing is a fundamental social determinant of health, and barriers to primary care for homeless populations typically result in higher rates of avoidable hospitalizations and increased long-term costs for public health systems.
How the residential requirement blocks healthcare access
In Italy, the Azienda Sanitaria Locale (ASL), or Local Health Authority, manages the distribution of GPs. The standard registration process requires a valid identity document and a registered residence within the ASL’s jurisdiction. For those without a home, this creates a “catch-22” where they cannot access a doctor without a home, and the instability of their housing prevents them from securing the legal residency required by the state.
While some municipalities have implemented “virtual residences” (residenza fittizia) to allow homeless people to vote or access certain social services, this administrative tool has not been uniformly applied to healthcare registration across the Lazio region. This inconsistency means a person’s ability to see a family doctor often depends on the specific policies of a local mayor rather than a guaranteed regional right.
The initiative led by Pierfrancesco Majorino proposes a standardized regional mechanism that would allow the ASL to assign a primary care physician to any person regardless of their housing status. This would move the care model from a reactive system—where patients are treated only during acute crises in emergency departments—to a proactive system focused on continuity of care.
The impact of primary care on homeless health outcomes
The absence of a designated GP significantly hinders the treatment of chronic diseases such as diabetes, hypertension, and HIV/AIDS among the homeless. Without a primary doctor to monitor medication adherence and provide regular check-ups, these conditions often escalate until they require emergency intervention. This puts additional strain on the Pronto Soccorso (Emergency Department) system, which is not designed for long-term disease management.
Medical professionals specializing in street medicine argue that the relationship between a patient and a consistent physician is critical for building trust. This trust is essential for diagnosing mental health issues and substance abuse disorders, which frequently co-occur with homelessness. By establishing a formal link to the SSN, the proposal intends to integrate homeless patients into the broader network of specialized care, such as cardiology or oncology, which usually requires a referral from a GP.
Furthermore, the proposal emphasizes the role of pediatricians for children living in precarious housing situations. Ensuring that children have a pediatrician of choice is vital for completing vaccination schedules and monitoring developmental milestones, which are often missed when families rely on fragmented emergency services.
Regional policy and the right to health
The proposal aligns with Article 32 of the Italian Constitution, which defines health as a fundamental right of the individual and a collective interest of the community. Supporters of the measure argue that administrative barriers like the residenza requirement effectively nullify this constitutional right for thousands of people.
The debate over healthcare access for the homeless is not unique to Lazio. Various European cities have experimented with “low-threshold” health centers that provide primary care without requiring formal documentation. However, the Lazio proposal differs by attempting to integrate these individuals directly into the existing national system rather than creating a separate, parallel service for the poor, which advocates argue can lead to lower standards of care.
Legal experts note that removing the residence requirement would require a shift in how the Ministry of Health and regional authorities track patient lists and allocate funding to GPs. Currently, doctors are paid based on the number of patients registered in their district; a new system would need to account for the high-intensity needs of homeless patients, who often require more time and resources than the average patient.
What happens next for the proposal
The proposal must now move through the Lazio Regional Council’s committee stages, where it will be debated and potentially amended before a final vote. If passed, the regional government would need to issue new directives to the ASLs to update their registration protocols and potentially provide incentives for GPs to take on patients with complex social needs.
Observers are watching to see if the regional administration will adopt a “virtual residence” model for all health services or create a specific “health-only” registration category. The outcome will determine whether the right to a doctor in the region is based on administrative status or on the actual medical need of the citizen.
The next official checkpoint for this initiative will be the scheduled regional health committee hearings, where the specific implementation details regarding ASL funding and doctor assignments will be discussed.
Do you believe healthcare access should be decoupled from residential status? Share your thoughts in the comments or share this article to join the conversation on health equity.