Trends in ARAN Basic Salary Scales for the Italian Healthcare Sector Collective Agreement over the Last 20 Years: Comparison with Inflation

Abstract

Background: The economic treatment of non-managerial healthcare personnel employed in the Italian National Health Service is regulated through national collective bargaining negotiated by ARAN. Over the last two decades, salary scales in the healthcare sector have been affected by delayed renewals, public-sector wage restraint, a long period of collective bargaining freeze, contractual reclassification and the recent inflation shock of 2022–2023. This systematic narrative review analyses the trend of ARAN basic salary scales for the Italian healthcare sector collective agreement over approximately the last 20 years and compares nominal increases with consumer price inflation.
Methods: A systematic narrative search was conducted in June 2026 using ARAN collective agreements, ISTAT consumer price data, World Bank/IMF inflation series, legal sources and institutional documents. The analysis focused on national basic salary tables, excluding individual seniority, allowances, overtime, performance-related pay and local supplementary bargaining. Because the classification system changed during the period, the former Category D entry level was used as a tracer profile and compared with the current “Health Professionals and Officials” area.
Results: Between 2004 and 2024, the annual gross basic salary for the tracer profile increased from approximately €19,380.15 in 2004 to €24,918.93 from 1 January 2024. This corresponds to a nominal increase of about 28.6%. Over the same period, consumer prices increased by approximately 45–46%, depending on the index and reference series used. The implied real loss of purchasing power for the basic salary component is therefore approximately 12%. The gap widened especially after the 2010–2015 public-sector bargaining freeze and again after the high-inflation period of 2022–2023.
Conclusions: ARAN salary scale increases for the healthcare sector have not fully compensated cumulative inflation over the last 20 years. Although the 2019–2021 and 2022–2024 agreements improved nominal pay and introduced important structural changes, the basic salary component remains affected by delayed contractual cycles and incomplete inflation recovery. Future bargaining should incorporate more responsive mechanisms for inflation protection, professional recognition and workforce retention.