Let’s be clear from the start: when you think of San Marino, you likely picture a medieval fortress perched on a mountain, not a bustling medical hub. And you’d be right. But here’s what might surprise you: nestled within this tiny, ancient republic is a healthcare system that punches far above its weight, offering its citizens—and often visitors—care that rivals its much larger neighbor, Italy.
San Marino is one of the world’s smallest countries, with a population of just over 33,000. Yet, it maintains a sovereign, modern healthcare system. For expatriates, digital nomads, or retirees considering life here, understanding this system is key. It’s not about finding a world-renowned specialty hospital; it’s about accessing reliable, high-standard European care within a unique and intimate community setting.
This guide will walk you through the practical reality of hospitals in San Marino. We’ll explain how the system integrates with Italy’s, what you can expect from the local State Hospital, and the crucial steps you need to take to ensure seamless care. If you’re drawn to the safety, beauty, and uniqueness of San Marino, knowing how to manage your health here is part of the adventure.
The Sammarinese Model: Sovereignty with Strategic Partnership
San Marino’s healthcare story is one of smart pragmatism. As a microstate entirely surrounded by Italy, it has developed a system that leverages its autonomy while relying on a deep partnership with the Italian region of Emilia-Romagna for highly specialized services.
The foundation is the Istituto per la Sicurezza Sociale (ISS)—the Institute for Social Security. This isn’t just a pension fund; it’s the single public entity that manages healthcare, pensions, and social services. Every resident contributes to and is covered by the ISS.
The local facility is the Ospedale di Stato (State Hospital) in the city of San Marino. It’s a modern, well-equipped facility that handles emergencies, routine surgery, diagnostics, and outpatient care. For anything beyond its scope—such as complex cardiac surgery, neurosurgery, or advanced oncology—patients are seamlessly referred to affiliated Italian hospitals, primarily in Rimini, a short drive down the mountain.
A Resident’s Perspective: Luca, a software developer who moved from the UK, explains: “Moving to a tiny country, I wondered about healthcare. What I found is incredible efficiency. I’m registered with the ISS and have a local GP. For my annual check-up and when I had appendicitis, everything was handled at the State Hospital. The care was excellent and personal. Last year, I needed a specialist ENT consult for a persistent issue. My GP wrote a referral, and I was seen at a top clinic in Rimini a week later, with the ISS covering the cost. It’s the best of both worlds: the community feel of a small hospital for everyday needs, and direct access to the Italian system for specialties.”
Understanding the Integrated System
To navigate healthcare here, you need to understand its hybrid nature.
- The Local Hub: Ospedale di Stato (State Hospital):
- This is San Marino’s only public hospital. It provides:
- 24/7 Emergency Department (Pronto Soccorso)
- Inpatient medical and surgical wards
- Operating theaters
- Diagnostics (modern lab, CT scanner, MRI, ultrasound)
- Outpatient specialist clinics
- Maternity unit
- It is staffed by Sammarinese and Italian doctors and is accredited to provide high-quality acute care.
- This is San Marino’s only public hospital. It provides:
- The Gatekeeper: Your Local GP (Medico di Famiglia):
- Upon legal residency, you must register with a Sammarinese General Practitioner. This doctor is your primary point of contact for all non-emergencies and is essential for obtaining referrals (impegnative) for specialists, tests, and hospital care—both locally and in Italy.
- The Extended Network: Italian Specialty Hospitals:
- Through formal agreements, the ISS has contracts with major hospitals in the Emilia-Romagna region, most notably the Ospedale Infermi di Rimini. For pre-authorized specialized treatments, you simply go there with your ISS referral. The billing is handled directly between the institutions.
- Private Italian Clinics:
- You also have the option to use private clinics and specialists in Italy. In this case, you pay upfront and then seek reimbursement from the ISS, which typically covers a portion of the cost (the equivalent public rate).
Overview of San Marino’s Primary Healthcare Facility
| Facility Name | Location | Type | Key Services & Role | For Residents & Expats |
|---|---|---|---|---|
| Ospedale di Stato (State Hospital) | City of San Marino | Public General Hospital | Emergency Care, Surgery, Inpatient, Diagnostics, Maternity. | Your local hospital for urgent and routine hospital-based care. |
| Istituto per la Sicurezza Sociale (ISS) | Throughout territory | Public Health Authority / Insurance | Registers residents, provides health coverage, processes referrals & reimbursements. | You must register here. This is your “health insurance company.” |
| Local GP Practices (Medici di Famiglia) | Various towns | Private-Public Primary Care | Primary consultations, prescriptions, referrals to specialists. | Mandatory to choose one. Your main doctor for everything non-urgent. |
| Affiliated Italian Public Hospitals | Primarily Rimini | Public Specialty Centers | Advanced specialties: Cardiology, Neurosurgery, Oncology, etc. | Accessed via referral from your Sammarinese GP. |
| Pharmacies (Farmacie) | Throughout territory | Private (with public role) | Dispense prescriptions; some offer basic medical advice. | Prescriptions from Sammarinese or Italian doctors are valid. |
What Care is Available Within San Marino?
You can expect the State Hospital and local GPs to handle a wide range of needs competently:
- Emergency & Trauma Care: Stabilization and treatment of accidents, heart attacks, strokes, and other acute conditions.
- Routine & Elective Surgery: Such as gallbladder removal, hernia repair, knee arthroscopies.
- Management of Chronic Conditions: Diabetes, hypertension, asthma, etc., through your GP and outpatient clinics.
- Diagnostics: Comprehensive blood tests, X-rays, CT scans, MRI, and ultrasounds.
- Maternity Care: From prenatal visits to delivery and postpartum care.
- Basic Dental Care: Available through the public dental service and private dentists.
Your Essential Steps to Access Healthcare in San Marino
Gaining access to this system is straightforward but requires following specific bureaucratic steps.
- Achieve Legal Residency: This is the fundamental prerequisite. You cannot register with the ISS without a valid residency permit (permesso di soggiorno). This typically involves proving financial means, health insurance during the application, and a rental contract or property deed.
- Register with the Istituto per la Sicurezza Sociale (ISS): Once you have residency, you must go to the ISS offices to register. You will receive a health insurance card (tessera sanitaria). This card is your key to the system. You will pay contributions based on your income or employment status.
- Choose Your GP (Medico di Famiglia): The ISS will provide a list of doctors accepting new patients. You must formally enroll with one. This doctor is your gateway for all referrals.
- Understand the Referral Pathway: For any specialist visit, diagnostic test (beyond basic ones), or planned hospital procedure, you need a referral (impegnativa) from your GP. This includes referrals to Italian facilities. Never book a specialist in Italy without this document if you want ISS coverage.
- For Emergencies: Go directly to the Pronto Soccorso (Emergency Department) at the State Hospital. Present your ISS health card. In a life-threatening emergency, call 118 (the universal European emergency number).
- Consider Supplemental Private Insurance: While the ISS coverage is comprehensive for essential care, some residents opt for private insurance to cover things like: private hospital rooms in Italy, faster access to non-urgent specialists, or treatments not fully covered by the ISS.
The Value of Community Insight in a Small State
In a community as small and interconnected as San Marino, practical wisdom is shared person-to-person. Which GP speaks the best English and is patient with new residents? What’s the process for getting a prescription filled from an Italian specialist? How does the reimbursement for a private MRI in Rimini actually work?
This is where connecting with fellow residents becomes incredibly helpful.
On MyHospitalNow, our forum for hospitals in San Marino is a space for this exact exchange of practical, lived experience.
From a Retiree from the US: “Navigating the switch from American health insurance to the Sammarinese ISS system was our biggest learning curve. The official guidelines are clear, but the nuances aren’t. I found the MyHospitalNow forum and asked about choosing a GP. The advice was gold—people explained which doctors had the best reputations for managing older patients with multiple medications. Someone even outlined the exact steps for getting a referral to a rheumatologist in Rimini. It saved us weeks of confusion. In a small place, the expat and local knowledge network is your best resource.” – George and Linda, Retirees
Whether you need advice on residency paperwork related to health, recommendations for a dentist, or experiences with specific departments at the State Hospital, this community can offer grounded support.
We host these discussions to foster this helpful network: MyHospitalNow’s Hospitals in San Marino Community.
Final Thoughts: Quality Care in a Unique Setting
Choosing San Marino is a choice for a specific lifestyle—safe, historic, community-oriented, and intimately connected to Italy. Its healthcare system mirrors this: it is personal, efficient, and provides high-standard European care through its unique hybrid model.
The key to accessing it is proper administrative integration. Once you are registered with the ISS and have your GP, the system works smoothly, offering a robust safety net and direct access to a wider regional network for specialized needs.