The State of the Art of the Pension System Associated with Regulated Healthcare Professions in Italy: Advantages and Disadvantages

Abstract

In Italy, regulated healthcare professions are embedded in a complex pension architecture that differs according to employment status, professional order, historical development of pension funds and availability of profession-specific social security institutions. Physicians, dentists, pharmacists, veterinarians, psychologists, biologists and nurses have dedicated professional pension funds or sectoral schemes, whereas many technical, rehabilitation and prevention healthcare professions organized under the FNO TSRM and PSTRP remain mainly covered by the INPS Gestione Separata when they practise as self-employed professionals. This systematic narrative review aims to analyse the state of the art of the pension system associated with regulated healthcare professions in Italy, with particular attention to legal framework, institutional models, advantages, disadvantages and equity implications.
Methods: A systematic narrative search was conducted in June 2026 using PubMed/MEDLINE, Google Scholar, official Italian legislative repositories, INPS, professional pension fund websites, federation documents and OECD reports. Search terms included “healthcare professions”, “professional orders”, “pension system”, “Italy”, “Gestione Separata INPS”, “professional pension funds”, “ENPAPI”, “ENPAM”, “ENPAF”, “ENPAP”, “ENPAB”, “FNO TSRM PSTRP”, “self-employed health professionals”, “advantages” and “disadvantages”. Official legislation, institutional documents, policy reports and peer-reviewed literature were included. Due to the heterogeneity of sources and the predominance of legal and policy materials, findings were synthesized narratively.
Results: The Italian system is characterized by three main pension pathways: (1) general compulsory social security through INPS for employed professionals, including public National Health Service employees; (2) profession-specific pension funds for some self-employed regulated professions; and (3) INPS Gestione Separata for self-employed professionals without a dedicated pension fund. Dedicated pension funds provide advantages such as professional identity, targeted welfare, autonomous governance, supplementary assistance and potentially more profession-sensitive contribution rules. However, they also raise concerns regarding financial sustainability, demographic risk, administrative costs and unequal treatment across professions. Conversely, INPS Gestione Separata provides universal mandatory coverage and administrative integration but is often criticized for its generalist design, limited profession-specific welfare and perceived inadequacy for emerging healthcare professions.
Conclusions: The pension system of regulated healthcare professions in Italy reflects historical stratification rather than a fully coherent interprofessional design. The main unresolved issue is equity between “historical” professions with dedicated funds and more recently organized healthcare professions that remain within generalist pension schemes. Future reform should balance autonomy, sustainability, portability, adequacy and interprofessional fairness.