English If you follow Italian media, you might have seen a few headlines this week about the “best hospitals in Italy” as Italy’s new Programma Nazionale Esiti (PNE) was released. While several media outlets took it as a chance to boast of their local hospital being the “best in Italy”, reality is a bit more complex. In this article we’ll look into these healthcare rankings, what they cover, and how to get further information on ailment-specific care in Italy.
What is AGENAS’s PNE? A Quick Explainer
The PNE is an annual national healthcare “report card” that evaluates hospital performance across the country. Run by AGENAS (the National Agency for Regional Health Services), the PNE tracks 218 quality indicators covering outcomes, volumes of procedures, timeliness of treatments, and appropriateness of care.
In simpler terms, it measures things like how often patients survive or recover without complications, whether hospitals perform enough procedures to maintain expertise, how quickly critical treatments are given (for example, after a heart attack), and if care follows best practices. The 2025 edition (based on data from 2024) marks ten years since new national hospital standards were introduced, and the report highlights how clear standards and consistent monitoring have helped improve care quality over the past decade. It’s a highly anticipated annual check-up on Italy’s health system, valued by clinicians and policymakers alike.
What is New in The 2025 PNE
This year’s PNE comes with a few notable updates and emphases.
- First, it uses an enhanced “treemap” composite evaluation – essentially grouping results into 8 key clinical areas (cardiac care, neurological, respiratory, general surgery, oncologic surgery, maternity & birth, orthopaedics, and nephrology) and summarising a hospital’s performance in each area. This multi-indicator approach paints a broad picture of each hospital’s strengths.
- Second, the 2025 report takes stock of progress since 2015’s hospital reform law (DM 70/2015), observing improvements in quality where services have been reorganised to meet those national standards. Finally, AGENAS has expanded the number of measures (now 218) and included data linkages – for example connecting hospital discharge records with vital status and emergency data – to give a more complete view of outcomes.
For expats and retirees reading this, the PNE might sound technical, but it really boils down to: how good is the care at your local hospital, and is the health system improving?
Italy’s Top-Performing Hospitals of 2024
One attention-grabbing outcome of PNE 2025 was a list of 15 hospitals that achieved high performance across multiple areas of care. AGENAS highlighted these as “top hospitals” that scored a “high” or “very high” quality rating in all the areas in which they were evaluated. Impressively, two provincial hospitals (Ospedale di Savigliano in Cuneo (Piedmont) and Ospedale di Mestre in Veneto) were the only facilities in Italy to earn the highest rating in all 8 clinical areas assessed. In other words, they got a perfect “8 out of 8,” marking them as exceptionally well-rounded in quality.
Several other hospitals came close, scoring high in 7 out of 8 areas – for example, Lombardy’s renowned institutions like Papa Giovanni XXIII in Bergamo and Humanitas Research Hospital in Milan each excelled in seven areas, as did Naples’ main university hospital A.O.U. Federico II (notably the only southern hospital in the top group). Rounding out the list were a mix of large and mid-sized hospitals across the North and Centre, such as Ospedale Maggiore di Lodi (Lombardy), Fondazione Poliambulanza in Brescia, Ospedale di Cittadella in Veneto, Fidenza in Emilia-Romagna, and others. Even smaller facilities like Montebelluna (Veneto) and Pontedera (Tuscany) made the cut.
It’s interesting that some big-name hospitals in major cities did not appear on this all-round excellence list, while several provincial hospitals shone. This underlines that quality isn’t solely about a hospital’s fame or size: organisation, consistency and adequate case volumes are what count. In fact, many of these top scorers are not huge metropolitan centres but have managed to deliver uniformly high standards in the services they provide. Expats or retirees might find reassurance that outstanding care can be found even in smaller cities.
It’s also worth noting that about 18% of hospitals (197 facilities) were flagged as underperforming (in Italian terms, “rimandati” or needing improvement), and the majority of those are in the South (especially in Campania and Sicily). This dichotomy sets the stage for one of the PNE’s key themes: the persistent geographical gap in healthcare performance.
Faster Heart Attack Care and Other Improvements
The 2025 PNE report also offers a wealth of insight into how care is improving (or not) across different clinical areas. One clear positive trend is in emergency cardiac care: hospitals have gotten faster at treating heart attacks. Nationwide, the median rate of timely angioplasty for heart attack (STEMI) – essentially the percentage of patients getting a coronary angioplasty within 90 minutes – has risen to 63% in 2024, up from 57% in 2020. That means more heart attack patients are getting rapid, lifesaving intervention than a few years ago. Similarly, outcomes of cardiac surgery have improved: for instance, the average 30-day mortality after coronary bypass surgery has dropped to around 1.5%, well below the 4% safety threshold. These are encouraging signs for anyone with cardiac concerns – if you have a myocardial infarction today in Italy, your odds of swift, effective treatment are better than ever.
Another area of progress is in complex cancer surgery. Italy has been working to centralise oncologic surgeries (like those for cancers of the breast, colon, lung, pancreas, etc.) into higher-volume centres, on the principle that “practice makes perfect” for surgical teams. The PNE data show this strategy is paying off, at least in many regions. For example, 90% of breast cancer surgeries nationwide are now performed in high-volume hospitals, up from 72% in 2015. Similar improvements were seen in other cancer types – the share of prostate cancer operations in high-volume centres jumped from 63% to 82%, and lung cancer surgery from 69% to 83% (2015 vs 2024). In plain language, far more patients today have their major cancer operations done in experienced hospitals, which is linked to better outcomes.
There are, of course, areas that still need work. One example is rectal cancer surgery, which remains problematic: results for curative rectal surgery were noted as “even more critical”, with low rates of cases handled in high-volume centres and even a worsening trend (only ~22% of cases in 2024 were done in top-volume hospitals, down from ~30% in 2015).
The PNE’s message here is that while some specialties have consolidated, others lag behind, which can affect quality. As a general trend, where hospitals have concentrated expertise, outcomes improve, but where caseloads are scattered, the quality can suffer.
North–South Gaps and Regional Insights
Reading the PNE, one theme comes up again and again: geographic disparities. Overall, Italy’s healthcare quality improves as you move north, and that pattern persisted in 2024’s data. The report explicitly states that despite overall progress, a marked North–South divide remains, especially in certain critical areas. For example, those impressive improvements in heart attack care aren’t uniform: some southern regions still have much lower rates of timely angioplasty, pulling down the average. In fact, the PNE notes that performance on life-saving procedures (like emergency angioplasty) tends to be “markedly worse in the South”.
Maternal and newborn care indicators also reflect the divide. A positive trend nationally is that primary C-section rates have modestly declined (from 25% of births in 2015 to about 22% in 2024), moving closer to international recommendations. However, this average hides huge regional differences: in Northern regions some hospitals are near the WHO-recommended 15% C-section rate, whereas in many Southern regions the rate is well above 25%. In fact, PNE calls out the “still too many caesareans in the South” as a persistent inappropriate practice.
It’s not all bad news for the South, of course. Some southern facilities do excel (recall Naples’ Federico II hospital made the top-15 list), and in certain areas like basic orthopedic care the gap is narrower. For instance, the prompt treatment of hip fractures in the elderly improved overall – nationally about 60% of seniors with a broken hip got surgery within 48 hours in 2024, up from 52% in 2020. Yet again, many southern regions fell short of the standard for timely hip fracture surgery. The pattern is consistent: care quality is improving across Italy, but more slowly in the South.
For expats and retirees, these regional insights can be quite useful. If you’re retiring to a charming small town in northern Italy, you can be confident the nearest hospitals likely meet high standards in many areas. If you’re in the South or a rural area, it’s good to be aware of which nearby hospitals are stronger and for which services you might need to travel to a larger centre. You can use our Town Explorer to assess the quality of healthcare across the regions or towns you are interested in.
How to Interpret the Results, and Their Limitations
For a general reader, the PNE report might seem like a simple ranking of “best hospitals.” However, it’s not a straightforward league table, and a high composite score should be interpreted with caution when making personal healthcare choices. The top-15 “all-round” hospitals earned their spot by doing well across many fields, which is great for overall quality. But if you have a specific medical condition, you’ll want to dig deeper. A hospital that is fantastic overall isn’t automatically the very best in every specialty. For example, a facility could excel in orthopedics, general surgery, and maternity (boosting its composite score), but be only average in, say, cardiology.
In practice, this means when choosing a hospital for a particular treatment, look at the relevant specific indicators, such as how well that hospital performs in cardiocirculatory outcomes or oncology surgeries, rather than just its composite rating. The PNE data can help with this, but often your doctor’s referral and the hospital’s reputation in that field are key factors too.
Remember that the PNE is primarily a governance and improvement tool, aimed at supporting clinicians and administrators to improve services, and at informing citizens where there are strengths or weaknesses in the system. It’s one piece of the puzzle. As AGENAS officials and even the Health Minister noted, the goal is to use these findings to ensure everyone has access to high-quality care, no matter their postcode. The report has already prompted action – for instance, hospitals with repeatedly poor results are placed “sotto audit” (under review), meaning they’ll get scrutiny and support to address issues. About 197 hospitals were flagged for audit/improvement this round(many of them in the South), while others have been celebrated as models to learn from.
In summary, the PNE 2025 tells a story of overall improvement in Italian healthcare with notable bright spots, but also enduring gaps that matter. For expats and retirees, it’s reassuring to see that outcomes (like heart attack survival and surgical success rates) are trending better, thanks in part to national standards pushing hospitals to up their game. The standout hospitals identified by AGENAS show that excellence is achievable across Italy – from big cities to smaller towns – and that some of the best care can be found in places you might not expect. At the same time, the regional disparities highlighted in the report are a reminder to be informed about your local healthcare landscape. Italy’s health system is highly regarded globally, and tools like the PNE ensure it keeps improving by shining a light on both its triumphs and its trouble spots. As a patient or health consumer, you should use this information as a guide – a way to ask the right questions and make the best choices for your care – while keeping its limitations in perspective.
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