Healthcare and old border workers: the contribution for the staff (cross-border guide)

Context

In a nutshell

• 20% increase in doctors' and nurses' salaries within 20km of the border
• Monthly contribution for old border workers between 30 and 200 euros
• Measure based on Financial 2024 to remedy regulatory gaps

• What: Contribution for health and increase in health salaries
• When: Announced in April 2026
• Where: Lombardy (Swiss border area)
• Who: Councillor Massimo Sertori and old border guards
• Amount: Salary increase 20%; contribution 3% - 6% of net income

According to what was communicated in April 2026, the Lombardy Region has outlined a plan to combat the flight of health professionals to Switzerland. The goal is to increase by 20% the salaries of doctors and nurses operating within a radius of twenty kilometers from the Swiss border, where the attractiveness of cross-border salaries — which can triple or quadruple compared to Italian ones — makes it difficult to hire new staff.

The details of the salary increase

The economic operation translates into concrete figures for health personnel: a doctor would receive about ten thousand euros more per year, while for a nurse the increase would be 5,400 euros. To finance this measure, the councilor for local authorities, Massimo Sertori, confirmed the intention to apply the contribution provided for by the 2024 Finance Act.

This levy would affect the so-called "old border workers", residents in Lombardy and workers in Switzerland who benefit from the binary system.

Operational details

Analysis of the binary system and acquired rights

To understand the impact of this measure, it is necessary to analyse the position of the old frontier workers. These workers paid the sick pay in Switzerland for themselves and, until 1999, a bill of about 600 thousand lire to allow family members to use the Italian National Health Service (SSN). Subsequently, with the transition of healthcare to the Regions and the Switzerland-EU agreement, the right of option was introduced.

Comparison of health options

The frontier worker, within three months, can choose between two distinct paths to healthcare:

| Option | Indicative Cost | Coverage | | :--- | :--- | :--- | | Swiss Health | Minimum 350 euros/month | Only the worker | | SSN Italian | Variable contribution (€30-200) | Worker and family members |

Councillor Sertori explained that, due to a regulatory vacuum, the old border workers have stopped paying the contribution for access to the SSN. The Finanziaria of 2024, promoted by Minister Giancarlo Giorgetti, aims to remedy this situation by introducing a contribution ranging between 30 and 200 euros per month.

The current management of the binary system was defended as the result of a dialogue started in 2018 with the Canton of Ticino to overcome the blockade of restaurants. The objective was to preserve the rights of those who had planned their family budget on certain incomes until the

Useful tools for your case

To verify your within/over 20 km tax scenario, use the net salary calculator and the tax return guide.

Key points

Application Procedures and Controls

The Lombardy Region has already begun the operational phase for the implementation of these payments. The assessor Sertori has stated that the administration is preparing the necessary applications for the collection of contributions. A critical point is the identification of the subjects obliged: the list of old frontaliers is currently held by the Swiss authorities, making direct access to the data for the Italian part difficult.

Despite the lack of an official list provided by Switzerland, the Region will proceed through the following operational steps:

1. Implementation of the informatic applications for the calculation of the contribution. 2. Request for self-certifications from workers residing in Lombardy and employed in Switzerland. 3. Execution of sample checks to verify the truthfulness of the declarations. 4. Issuance of payment vouchers based on the percentage of net income (3%-6%).

For those working in Switzerland, it is essential to monitor one's fiscal and insurance position. Although the payroll tax will be deducted in Switzerland, access to Italian healthcare services for Lombardy residents will now be linked to the payment of these contributions, which vary from 30 to 200 euros per month.

For those who wish to assess the impact of these deductions on their net salary or compare healthcare costs between the two countries, they can use the calculation tools available on our portal. It is useful to periodically verify the update of the fiscal norms to avoid sanctions related to self-certifications.

For a precise calculation of your net salary and applicable deductions, use our calculator.

Source: ilgiorno.it