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Italy experiences higher catastrophic health spending than many EU countries, predominantly affecting low-income, southern-region, and pensioner-headed households, driven by outpatient medicines and care for poorer groups and dental care for wealthier ones. Significant disparities in unmet healthcare needs exist between rich and poor, linked to factors such as long waiting times, high co-payments, limited dental and medical product coverage, and regional inequalities. To improve financial protection and equity, the government should increase and target public health spending, reduce co-payments, expand coverage, address regional disparities, and extend health entitlements to adult undocumented migrants.