Italy—Why It's the
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The Italy Question: Why Smart Expats Choose It Over Spain (But Nobody Talks About It)
If you’ve been researching European relocation, you’ve heard about Portugal (affordable), Spain (popular), and Greece (sun-soaked). Italy is the elephant in the room: spectacular quality of life, world-class healthcare, but it’s overlooked because it’s not a “trend destination.”
Here’s the uncomfortable truth: Italy has better infrastructure, healthcare, food culture, and lifestyle than any comparable country—at nearly identical costs to Spain.
This guide covers why Italy is the best-kept secret in European relocation and whether it makes sense for your situation.
The Healthcare Advantage: Italy Ranks #2 Globally
Healthcare rankings (WHO/Numbeo 2024):
| Country | Rank | Quality Score |
|---|---|---|
| France | #1 | 9.1/10 |
| Italy | #2 | 8.9/10 |
| Spain | #9 | 8.2/10 |
| Portugal | #4 | 8.6/10 |
| Germany | #5 | 8.5/10 |
| Greece | #14 | 7.8/10 |
What this means practically:
- Hospitals rival Germany/Switzerland in equipment
- Doctors speak English (especially in cities)
- Wait times: 1-2 weeks for specialists (vs Spain’s 3-4 weeks)
- Public healthcare costs: €3-8/month for those 65+
- Retirees save €200-400/month on healthcare vs Spain/Portugal
Reality check: Italian healthcare is actually excellent. It’s not trendy to say so, which is why Portugal gets the attention instead.
Cost of Living: Italy is Cheaper Than Spain in the South
Monthly living costs comparison (2026):
| City | Italy | Spain |
|---|---|---|
| Rome | €2,200-2,700 | €2,300-2,800 |
| Naples | €1,400-1,800 | €1,600-2,000 |
| Sicily (Palermo) | €1,200-1,600 | €1,500-1,800 |
| Sardinia | €1,500-2,000 | €1,700-2,100 |
| Milan | €2,700-3,200 | €2,600-3,100 |
| Tuscany (rural) | €1,600-2,100 | €1,800-2,300 |
The pattern: Southern Italy (Naples, Sicily, Calabria) is 15-25% cheaper than equivalent Spanish cities.
Why the mismatch? Spain is more “touristy” and has inflated rents. Italy’s south is less discovered by expats, so prices haven’t inflated.
Property Market: 40% Cheaper Than Spain
Average property prices (2026):
| Market | Italy | Spain | Difference |
|---|---|---|---|
| Coastal | €4,000-6,000/m² | €6,000-10,000/m² | -40% |
| City centers | €5,000-8,000/m² | €7,000-12,000/m² | -35% |
| Rural | €1,500-2,500/m² | €2,000-3,500/m² | -30% |
Real examples:
What €300,000 buys:
In Italy (Sicily):
- 3-bed villa with garden
- Rural location, 30 min to Palermo
- Swimming pool possible
- Fully renovated
In Spain (Andalusia):
- 2-bed townhouse
- Similar distance to Granada
- No outdoor space
- Needs updating
The investment angle: Italian property south of Rome is undervalued and appreciating. Savvy investors buy in Naples/Sicily for 50-year holds.
Food & Lifestyle (The Intangibles That Matter Most)
Why Italy wins on quality of life (this can’t be quantified but it matters):
✅ Food culture: Italy IS where your food comes from. You’re eating ingredients at source.
- Pasta: €0.80/kg (vs Spain €1.50)
- Vegetables: Market prices (not supermarket markup)
- Wine: €3-8/bottle for incredible quality (vs Spain €5-12)
- Coffee culture: Espresso is €1, not €3 (Spain)
✅ Work-life balance: Italians take lifestyle seriously
- Lunch culture: 2-hour midday breaks standard
- Siesta tradition: Shops close 1-3pm, life slows down
- Vacation: 4-5 weeks standard
- Social life: Walking towns, piazzas, village culture
✅ Architecture & aesthetics: Italy is museum-quality
- Medieval villages with history (not modern sprawl)
- Roman ruins accessible (not cordoned off)
- Design sensibility (even apartments are beautifully designed)
✅ Social infrastructure: Italy excels at public life
- Piazzas (public squares) as social centers
- Pedestrian-friendly cities (esp. south)
- Markets integrated into daily life
- Stronger community bonds than Spain/Portugal
The Visa Pathways: 4 Realistic Routes to Italy
Route 1: Elective Residency (D Visa Equivalent)
Requirements:
- €1,200-2,000/month passive income (lower than Spain!)
- Health insurance
- Clean background check
- Duration: 1-2 years, renewable
Cost: €1,200-2,000/month (income requirement) + €300-800 (legal/processing) Timeline: 2-3 months Best for: Retirees, passive income receivers
Reality: Less competitive than Spain D7. Easier to get approved.
Route 2: Digital Nomad Visa
Requirements:
- €2,400/month income (freelance/remote work)
- Health insurance
- Duration: 1 year, renewable
Cost: €2,400/month minimum + €200-500 setup Timeline: 3-4 weeks Best for: Digital nomads, remote workers
Reality: Italy’s newer pathway, less saturated than Spain.
Route 3: Self-Employment/Entrepreneur
Requirements:
- Business registration (partita IVA)
- Income declaration
- Duration: Permanent (if business legitimate)
Cost: €500-1,500 business setup + €1,000-2,000 legal Timeline: 4-8 weeks Best for: Freelancers, entrepreneurs, consultants
Reality: Like Spain’s startup visa but with lower requirements.
Route 4: Employment
Requirements:
- Job offer from Italian employer
- Duration: Tied to employment contract
Cost: €0-500 (employer usually handles) Timeline: 4-6 weeks Best for: Skilled workers (teachers, tech, healthcare)
Reality: Italian salaries are lower than Spain/Germany, but low cost of living compensates.
Regional Strategy: Where to Go Based on Your Priorities
For Families (Best Schools + Community)
Top Choice: Tuscany (Florence Region)
- International schools present (British School, International School)
- Strong expat communities (lots of other families)
- Excellent food/wine culture
- Healthcare: World-class (Florence has top hospitals)
- Cost: €2,000-2,800/month
- Best for: Quality of life + schools
Secondary: Milan + Surrounding
- More schools, more corporate opportunities
- Higher cost but more cosmopolitan
- Healthcare: Excellent
- Cost: €2,700-3,200/month
For Retirees (Healthcare + Lifestyle + Affordability)
Top Choice: Sicily (Palermo/Mondello)
- #2 healthcare globally (doctors speak English in Palermo)
- Cost of living: €1,200-1,600/month
- Mediterranean climate (mild winters)
- Active retiree community (growing)
- Healthcare: Good public system + private options
- Best for: Affordable luxury on €1,500/month
Secondary: Amalfi Coast
- Stunning lifestyle, famous wine region
- More expensive (€2,000-2,500/month)
- Better services than Sicily
- Healthcare: Excellent
- Best for: Premium lifestyle willing to pay
For Remote Workers (Community + Affordability)
Top Choice: Naples + Surrounding
- Growing digital nomad community
- Excellent food culture
- Cost: €1,400-1,800/month
- Co-working culture developing
- Healthcare: Good public system
Secondary: Bari (Puglia Region)
- Emerging digital nomad hub
- Very affordable (€1,200-1,500/month)
- Beach lifestyle
- Healthcare: Adequate
- Best for: Budget-conscious remote workers
For Entrepreneurs (Business Infrastructure)
Top Choice: Milan
- Best business environment in Italy
- Tech startup scene growing
- Networking opportunities
- Cost: €2,700-3,200/month
- Healthcare: Excellent
- Best for: Building businesses in Italy
The Honest Trade-Offs
Bureaucracy: Italy is Slightly Worse Than Spain
- Paperwork is Italian-language only (less English support)
- Processing times: 20% slower than Spain
- System is more opaque
- Solution: Hire immigration lawyer (€500-1,500)
Verdict: Similar headache, slightly more frustrating.
Language Barrier: Higher Than Spain/Portugal
- English spoken in tourist areas, limited elsewhere
- Professional/business environment: Better English
- Working with government: Mostly Italian
- Solution: Take A2 Italian course (3-6 months)
Verdict: Steeper learning curve, but doable.
Government Instability: More Volatile Than Spain
- Italy changes governments every 2-3 years (average)
- Policies shift more frequently
- Political uncertainty (vs Spain’s stability)
- Solution: Long-term mindset required
Verdict: Accept that Italy is less stable politically but stable economically.
Banking: Can Be Difficult (Like Spain)
- Italian banks also skeptical of foreigners
- Solution: Use Wise, Revolut, ActivoBank (same workaround as Spain)
Verdict: Same problem, same solutions.
Cost Comparison: Italy vs. Spain vs. Portugal vs. Greece (5-Year Horizon)
Scenario: Family of 4, urban center, €2,000/month budget
Italy (Naples):
- Housing: €900/month
- Healthcare: €100/month (public insurance)
- Food/utilities: €600/month
- Schools: €4,000/year international (optional, public free)
- 5-year total: €150,000
Spain (Valencia):
- Housing: €1,000/month
- Healthcare: €150/month (private insurance)
- Food/utilities: €700/month
- Schools: €5,000/year international
- 5-year total: €165,000 (€15,000 more expensive)
Portugal (Lisbon):
- Housing: €1,200/month
- Healthcare: €100/month (public)
- Food/utilities: €600/month
- Schools: €6,000/year international
- 5-year total: €178,000 (€28,000 more expensive)
Greece (Athens):
- Housing: €800/month
- Healthcare: €0/month (public, free)
- Food/utilities: €500/month
- Schools: €4,000/year international
- 5-year total: €141,000 (€9,000 cheaper than Italy)
Winner by cost: Greece Winner by cost + healthcare: Italy Winner by cost + lifestyle + healthcare: Italy
Why Italy Is Overlooked (The Psychology)
Why Portugal got trendy:
- Digital nomad marketing (cheap + easy)
- Tax advantages (NHR)
- English speakers (colonial legacy)
Why Spain remains popular:
- Trendy culture (Barcelona, Valencia)
- Beckham Law (entrepreneurs)
- Mediterranean stereotype
Why Italy is overlooked:
- Bureaucracy reputation (same as Spain actually)
- Language barrier (steeper than Spain/Portugal)
- Perception of instability (political, not economic)
- Less “expat marketing” (Italy doesn’t promote itself)
Result: Savvy expats find Italy. Tourists and trend-followers find Spain/Portugal.
The Reality Check
Who should move to Italy: ✅ Retirees with €1,200-1,500/month income ✅ Families willing to learn Italian ✅ Remote workers wanting lifestyle over hustle ✅ Food/culture enthusiasts ✅ Property investors in south
Who should skip Italy: ❌ English-only speakers (unwilling to learn) ❌ People needing maximum English-speaking services ❌ Those wanting “easy” move (bureaucracy is real) ❌ Tech entrepreneurs (Milan only, smaller scene than Spain) ❌ Those needing frequent international travel (less convenient)
The Path Forward: If Italy Interests You
- Spend 2 weeks there (not tourist areas, real towns)
- Talk to locals (Reddit /r/italy has many expats)
- Calculate actual costs for your chosen region
- Consult immigration lawyer (€500-1,000 initial)
- Commit to 1-year trial (rent first, buy later)
- Start Italian A1 language (3-6 months before move)
Final Thought
Italy is proof that the best-kept secrets stay secret because they’re not trendy. Spain is wonderful. But Italy is equally wonderful with better healthcare, cheaper property, and less overcrowding.
The fact that you don’t see Instagram influencers flooding to Naples is exactly why Naples is the better choice.
Next Steps
Ready to explore Italy as your relocation destination? Use our Italy relocation planner to calculate costs, visa options, and best regions for your situation.
Sources
- WHO Global Healthcare Rankings 2024
- Numbeo - Cost of Living Italy vs Spain/Portugal
- Italian Ministry of Interior - Visa Requirements 2026
- Elective Residency Association - Italy Visa Data
- Real estate sites: Immobiliare.it, Subito.it
- InterNations - Italy Expat Community Data
- Italian Chamber of Commerce - Healthcare and Residency Info
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