Italy boasts several high-performing hospitals, but achieving uniform excellence remains a distant goal. The latest National Outcomes Program from Agenas assessed 1,117 public and private facilities across eight key medical areas, ranging from oncology and cardiovascular surgery to maternity care.

Only 15 hospitals met all performance standards established in 2015, achieving high or very high results in every category. Fourteen of these top performers are located in central and northern regions—five in Lombardy, three in Veneto, two in Emilia-Romagna, and one each in Tuscany, the Marche, and Umbria. The sole southern standout is Naples’ Federico II University Hospital. Out of 117 hospitals evaluated across all eight domains, only two achieved uniformly high scores.

At the opposite end, 198 hospitals exhibit significant weaknesses and would benefit from voluntary improvement audits. A total of 333 critical issues were identified, with the largest problems found in maternity care and cardiovascular services. Regional disparities are stark: Campania has 51 underperforming hospitals, followed by Sicily (43), Puglia (19), and Calabria (12). Even Lombardy, often considered a national benchmark, has 14 facilities flagged for improvement.

Performance varies greatly by specialty. In cardiovascular care, many of the top-scoring hospitals are in Lombardy, while Lazio’s hub-and-spoke emergency network has helped reduce heart-attack cases by 21% in a decade. High-performing neurological centers are concentrated in the Centre-North. Excellence in oncology surgery is strongest in Lombardy, Piedmont, and Emilia-Romagna, though other regions, including Campania and Sicily, also feature standout facilities.

Maternity care remains one of the system’s most troubled areas. While 53 hospitals earn “very high” ratings, Italy’s rate of C-sections—22% in 2024—remains well above the 15% threshold recommended by the WHO. The divide is pronounced: many regions in the South show median rates above 25%, with peaks of 30–35%. Additional concerns include the continued operation of birth centers performing fewer than 500 deliveries a year, despite regulations requiring their closure.