The Segreteria di Stato per la Sanità e la Sicurezza Sociale sets health policy, while the ISS manages the public system across San Marino. The Ospedale di Stato in Cailungo provides general and specialist diagnosis and treatment, outpatient and inpatient care, paediatrics, rehabilitation, pain care and palliative pathways. UOC Salute Mentale provides mental health services. Primary care, health promotion, nursing, vaccinations and other basic services are available through the Centri Salute. A normal Medicina Generale or Medicina di Base consultation usually requires an appointment. An acute problem first receives a nursing urgency assessment, and a home visit may be arranged when medical or social immobility makes travel unsuitable. The ISS vaccination programme includes vaccinations required under San Marino's national delegated decree and other vaccinations based on risk or individual request. Vaccinations outside the applicable programme may be charged. Colon screening uses a faecal occult blood test for men and women aged 50 to 75, normally repeated every two years after a negative result. Cervical screening uses a Pap or HPV test for women aged 20 to 65. San Marino also offers STI counselling, testing and treatment, free PrEP through the ISS after a medical consultation, reproductive counselling through UOS Salute Donna and a youth clinic for people up to age 20. The CUP is the centralized booking service for outpatient and specialist diagnostic care; waiting times depend on capacity and are published. Medicines are obtained through an ISS prescription and pharmacies. An international pharmacy can help with medicines that are difficult to obtain, innovative, orphan or affected by market shortages. For sudden severe illness, serious accidents, urgent hospital admission or danger to life, call 118 San Marino Soccorso. The service is free and available 24 hours a day. Its operations centre assesses the situation, sends the necessary staff and resources and can arrange transport to the Ospedale di Stato. A mobile call may initially reach an Italian neighbouring emergency centre and then be transferred to San Marino. Urgent admission normally proceeds through the Pronto Soccorso. Planned admission can be arranged through a general practitioner, specialist, emergency department or hospital ward. Residents covered by the ISS generally receive hospital services without direct payment under the applicable rules, although some services may be chargeable; people outside ISS coverage may receive a separate bill. Planned treatment outside San Marino, or in private facilities inside or outside the country, is handled as Prestazioni Fuori Territorio (PFT). ISS authorization is normally required before treatment, and reimbursement requires the authorization process, invoice and proof of payment. Exceptional severity or urgency can remove the need for prior authorization. The Fascicolo Sanitario Elettronico (FSE) stores findings, prescriptions, appointments and clinical history. Adult ISS-assisted users can activate access personally through the URP and a public-administration account; a family head can access information for minors where permitted. SMS and email reminders may be available, and PFT applications can show the statuses IN ATTESA, AUTORIZZATA or RIFIUTATA and support online reimbursement. People receiving home or long-term care may be assessed by UOC Territoriale Domiciliare, which can create an individual care plan for temporary or permanent immobility, lack of transport, advanced age, frailty or access barriers. UOC Assistenza Residenziale Anziani manages public and contracted Casa Protetta and RSA services; typical access requires age 65 or older, citizenship or at least two years of residence, an active ISS number and a BINA assessment score above 290, followed by an application, home visit and possible waiting list. The executive committee can approve age exceptions. Users have rights to equal treatment, impartiality, continuity, information, participation, access to their own health data, choice within the law and the submission of complaints or suggestions. They must provide accurate information, show identity and Tessera Sanitaria documents when required, follow consent and data-protection rules and comply with medical instructions. Local vaccination duties apply where San Marino law requires them. San Marino had 33,733 inhabitants in 2023, and its ageing population increases the practical relevance of primary care, prevention, chronic disease management, mental health and long-term care. A WHO current health expenditure estimate placed spending at 7.98% of GDP in 2021.
Health in San Marino
Health care in San Marino is organized nationally through the Istituto per la Sicurezza Sociale (ISS), which provides primary care, hospital treatment, prevention, medicines, mental health services and long-term care. Residents with an active ISS relationship usually access services with a Tessera Sanitaria, while eligibility for foreign residents and other coverage situations depends on the individual case. Routine care starts with Medicina Generale or a Centro Salute; emergencies use the free 24-hour 118 service.
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