Healthcare, education and bureaucracy: in Italy only one citizen out of two is satisfied

Note by Nicolò Geraci Based on surveys published by the OECD, this note compares the level of satisfaction of citizens in 30 member countries with four key public services: health, education, justice and administration. The level of satisfaction in Italy is always lower than the OECD average, while citizens of Northern European countries are among the most satisfied in all four areas.

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The OECD ’s biennial publication Government at a Glance analyses comparable data on the quality of public services. The 2025 edition includes the results of a Trust Survey conducted in October and November 2023 among 60,000 people in 30 countries (of 38 OECD countries, the main omission is the United States). [1] The survey measured citizens’ satisfaction with healthcare, education, justice and general administration. This note reviews the results.

Two caveats for interpreting the data:

the assessment of the quality of public services may also depend on the different expectations in the various countries. These may in turn reflect the level of taxation: countries, such as emerging countries, where taxes are usually lower may be characterized by lower expectations and, therefore, with the same quality of services, record more positive assessments than those of advanced countries. To take this into account, in the following we focus largely on the comparison between Italy and advanced countries, although we also provide information on other OECD countries.

In other surveys, Italians seem to appear structurally more severe than citizens of other nationalities in evaluating their country. It is known, for example, that the level of perceived corruption is higher in Italy than more objective measures of the degree of corruption. [2] However, this cannot become an alibi to completely ignore the following results that are not flattering for Italy.

1. Health

When asked “On a scale of 0 to 10, how satisfied or dissatisfied are you with the healthcare system as a whole?” only 48% of Italians interviewed declared themselves “satisfied” (a term which, here and below, indicates a score of 6 or above) (Fig. 1). The Italian figure, in twenty-first place out of thirty countries for which results are available for 2023, is lower than the OECD average (52%) and is very far from the best (Belgium, Switzerland, Luxembourg, South Korea), where between 72% and 81% of interviewees are satisfied. We are also in last place among the largest countries, behind France (61%), Spain (58%), Germany (53%), the United Kingdom (50%) and Canada (49%). Some emerging economies such as Costa Rica (56%) and Mexico (53%) also record better results.

Compared to the 2021 surveys (the first edition of the program, in which Italy did not participate), in 2023 the results worsen for all countries except Belgium, Australia and Colombia, with a particularly strong decline in Northern Europe (average of minus 15 percentage points between Denmark, Norway and Finland), the United Kingdom (minus 19 pp), Canada (minus 12 pp) and France (minus 6 pp). Such widespread and, in some cases, marked worsening can be traced back to three factors: the lengthening of waiting lists caused by the postponement of healthcare services during Covid, the increase in those who declare they choose not to seek treatment and the return to more severe judgments after the Covid crisis, during which the healthcare system would have enjoyed greater appreciation as the essential nature of its role was evident. [3]

2. Education

Despite public spending being low and decreasing, the education system in Italy is more appreciated than in France, Germany and Spain. [4] According to the OECD survey, in 2023 51% of Italian respondents declared themselves satisfied, compared to 50.6% in Spain, 47% in France and 41% in Germany (Fig. 2). However, all four countries recorded values ​​much lower than the OECD average (57%). Decidedly positive assessments were found in Canada (68%) and in Northern Europe: 81% of respondents declared themselves satisfied in Finland, 74% in Denmark, 71% in the Netherlands, 68% in Ireland, 64% in Belgium and 62% in Sweden. Mexico and Costa Rica also stated they were satisfied, both with 64%.

3. Justice

Since it is a service with which citizens interact less frequently than health and education, OECD surveys in this area look at trust in the judicial system, rather than measuring the satisfaction of respondents. In Italy in 2023 only 43% of respondents declared themselves confident (score above 5), compared to 45% in Spain, 50% in France, 58% in Germany and 54% of the OECD average (Fig. 3). In this case too, Northern Europe leads the ranking: in Norway, Denmark, Finland and the Netherlands between 72% and 77% of respondents declared themselves confident. A similar ranking among the leading EU economies is obtained by comparing the average duration of civil proceedings: in 2022, to resolve a dispute that reached the final degree of judgment, 2,356 days were necessary in Italy, 1,393 in Spain, 1,309 in France and 532 in Germany. [5]

4. General administrative services

Italy is second to last in terms of satisfaction with general administrative services, such as requesting an identity document or applying for a social bonus. In 2023, 48% of Italian respondents declared themselves satisfied; only Portugal does worse (43%; Fig. 4). Among the shortcomings of our services, OECD surveys highlight the lack of attention to collecting and analyzing user feedback, combined with the limited use of performance objectives that guide improvement. [6]

The main advanced countries are well above Italy: Germany (51%), France (52%), Spain (57%) and the United Kingdom (74%), although sometimes below the OECD average (66%). No longer surprisingly, Northern Europe leads the ranking, led by Luxembourg (84%), Estonia (83%) and Finland (83%).

[1] Austria and Japan participated in the survey in 2021 (21 countries involved) but not in 2023 (30 countries involved), so the figures reporting the results of both editions provide an overview of a total of 32 countries.

[2] See the ANAC note at this link , which reports a strong increase in the perception of corruption in 2023 compared to 2012, with the ISTAT report, here , which instead indicates a decrease in declared cases in 2022-23 compared to 2015-16. For an extended discussion see, for example, Carlo Cottarelli, The Seven Deadly Sins of the Italian Economy, Chapter II, 2018, Feltrinelli, Milan.

[3] See our previous note, “ The open question of waiting lists ”, 28 June 2024.

[4] On the Italian case see our previous note “ Public spending on education in Italy: low, decreasing and unbalanced towards the less advanced levels ”, 26 November 2024.

[5] The duration of trials is measured by disposition time , i.e. the ratio between the stock of trials pending at the end of the year and the flow of trials concluded in that year multiplied by 365, so as to express it in days. In this regard, see our note “ The times of civil justice have been reduced… but not enough ”, 2 May 2025. This note highlights a clear improvement in Italy in the period 2012-22, although it remains behind the other countries cited in the text.

[6] OECD, Government at a glance – 2025, 2025, Paris, pp.80-81.