Before you choose a town on Italy's 7% tax map, look at the healthcare map too

If you have been looking at Italy's 7% pensioner tax map, you have probably been looking at the south.

That makes sense. The map covers 2,535 Italian towns and counting, and 2,424 of them sit in eight southern regions: Abruzzo, Basilicata, Calabria, Campania, Molise, Puglia, Sardinia and Sicily. The rest come from two earthquake routes in central Italy.

When you are choosing where to retire, though, the tax rate is only one of the things you will live with every day. Healthcare is another, and it often becomes more important with every passing year.

So I put the two maps side by side. What I found is that they work at very different levels. The tax map works town by town. The healthcare map works region by region, and in some of the most useful detail, province by province. Reading them together tells you quite a bit more than either one on its own.

First, how the tax map works

The 7% regime looks at the town you move to. Since April 2026, a town in one of the eight southern regions can be on the map if it has no more than 30,000 residents. The limit used to be 20,000.

In practice, that means almost every town in the south is on the map, but many of the people are not. The larger towns and cities fall outside it.

• In Campania, 508 of 550 towns are on the map, but they hold 47% of the region's residents.
• In Sicily, 359 of 391 towns are on the map, also with 47% of residents.
• In Puglia, 231 of 257 towns are on the map, with 52% of residents.
• In Molise, 134 of 136 towns are on the map, with 72% of residents.

I mention this because it changes the picture of daily life a little. A town on the map is, by definition, a smaller place. For many of us that is exactly the appeal. It also means the larger town with the specialist clinic, the bigger hospital or the airport may be some distance away.

Then, how the healthcare map works

Italy has a national health service, but each region runs its own part of it. Every year, the Ministry of Health scores each region in three areas, from 0 to 100, with 60 as the official sufficiency line:

• Prevention: vaccination, screening and public health programs.
• Community and district care: family doctors, outpatient care, and care for chronic conditions outside the hospital.
• Hospital care: how well the hospital system performs.

Because the region runs the system, every town in a region shares the same three scores. A small village in the hills of Molise and the regional capital, Campobasso, have the same numbers.

This is how the eight southern regions compare.

A few things stand out to me.

Puglia and Abruzzo score 74 or higher in all three areas. That puts them comfortably above the sufficiency line, although still well below the strongest regions in the north. Tuscany, for comparison, scored 96, 94 and 90.

Two regions fall below the line in one area each. Sicily scores 49 for prevention, while its community care and hospital scores are both above 70. Calabria scores 52 for community care, the part of the system you would use most often, for a family doctor or a routine appointment.

Molise sits exactly on the line, at 60, for hospital care. Campania has the highest community care score of the eight, at 80, but only just clears the line on prevention, at 61.

So the regions differ, and they differ in different ways. A region that is strong on hospitals may be weaker on screening, and the reverse. It is worth looking at all three scores rather than an average of them.

The province level: where people actually go for healthcare

The regional scores describe the system. ISTAT's well-being data (known as BES) adds a different kind of picture at the province level, including how long people live and how often they leave their own region for a hospital stay.

That last figure turned out to be the most striking one for me. ISTAT counts the share of hospital stays by a province's residents that take place in another region. I looked at ten southern provinces where almost every town is on the 7% map.

In Matera, more than a third of residents' hospital stays, 35.3%, take place outside Basilicata. That is the highest share of any Italian province in ISTAT's data. In Isernia and Campobasso, the two provinces of Molise, the figure is about one in three as well.

At the other end, in Oristano in Sardinia and Siracusa in Sicily, it is closer to one in fifteen.

I would be careful about reading too much into either end, for two reasons.

The first is geography. Matera sits close to the border with Puglia, and for many people there, the nearest large hospital may simply be in the next region. Teramo, at 22.1%, borders Marche. A high share can reflect a short drive across a regional line as much as a gap in local care.

The second is that a low share can have more than one explanation, too. Sardinia and Sicily are islands, and leaving the region for a hospital stay involves a ferry or a flight. Siracusa also has the lowest life expectancy in the table, at 81.5 years, which puts it in the bottom 2% of Italian provinces, and its avoidable mortality is among the highest in the country.

Isernia shows how mixed the picture can be inside one province. It has one of the highest numbers of beds in high-care hospital wards in Italy, 5.1 per 10,000 inhabitants, and more medical specialists per person than any other province in the table. A third of its residents' hospital stays still take place in another region, and its life expectancy is in the bottom 6% of provinces.

What the two maps tell you together

None of this suggests that the south is a bad place to grow older, or that the towns on the 7% map are a poor choice. Life expectancy in every province in the table is above 81 years, and several of the regions score well above the sufficiency line in all three areas. Many people retire in these regions and receive very good care.

It just means the tax map and the healthcare map answer different questions. The first tells you what you might pay. The second gives you a sense of the system you would rely on, and of how far you might need to travel to use it.

Before choosing a town on the map

If you are weighing towns on the 7% map, these are the questions I would look at first.

Which region would you be in, and which of its three scores is the weakest? If prevention is low, it is worth asking how screening works locally. If community care is low, it is worth asking how easy it is to register with a family doctor and get a routine appointment.

Where is the nearest hospital, and is it in the same region? In provinces like Matera, Isernia and Campobasso, the hospital many people use may be across a regional border. That is often fine, but it is good to know before you move rather than after.

Which larger town would you depend on? Because the 7% map leaves out the bigger towns, it is worth picturing the drive to the nearest one, in winter, and in ten years' time.

How would you manage without a car? A twenty-minute drive is easy at sixty-five. It may feel quite different at eighty.

A few important limitations

The healthcare scores describe a whole region. Every town in a region shares the same three numbers, and they cannot tell you how long you would wait for a particular appointment or whether a doctor nearby speaks English.

Province figures average very different places. A province includes its capital and its smallest mountain villages, and the BES figures describe all of them together.

The hospital-stay figure counts where residents were treated, for whatever reason. It includes people who chose a hospital across the border because it was closer, and people who traveled far for a specialist treatment. The data does not separate the two.

Population statistics describe residents, not you. Life expectancy reflects the whole population of a province over many years. It does not transfer directly to someone arriving with their own health, income and habits.

The 7% map describes towns, not people. Whether the regime applies to you depends on your income and where you were tax-resident before, so it is worth checking whether you qualify with a professional before planning around it. You can read how the regime works in our earlier piece, and more about the three regional scores in our piece on healthcare by region.

A note on the numbers

The 7% map applies the regime's geographic rules to ISTAT's resident population at 1 January 2025, with the criteria last checked against the law in August 2026. Regional healthcare scores come from the Ministry of Health's Nuovo Sistema di Garanzia for 2024, the newest year published; it scores Trentino-Alto Adige's two autonomous provinces separately, so that region does not appear on our healthcare maps. Province figures come from ISTAT's BES well-being data: life expectancy for 2024, medical specialists and hospital stays in another region for 2023, and hospital beds and avoidable mortality for 2022. You can open every region and province in this piece on its own page, with the source and year next to each number.

If you live in one of these provinces, I would love to hear how healthcare has worked for you in practice. Have you needed to travel to another region for treatment, or have you found everything you needed close to home?