Healthcare and old border workers: the contribution for the staff

Context

TL;DR

• 20% increase in doctors' and nurses' salaries within 20km of the border
• Monthly contribution for former cross-border workers between 30 and 200 euros
• Measure based on the 2024 Budget Law to address regulatory gaps

• What: Contribution for healthcare and increase in healthcare workers' salaries
• When: Announced in April 2026
• Where: Lombardy (Swiss border area)
• Who: Councillor Massimo Sertori and former cross-border workers
• Amount: 20% salary increase; contribution of 3% - 6% of net income

According to what was announced in April 2026, the Lombardy Region has outlined a plan to counter the exodus of healthcare professionals to Switzerland. The aim is to increase the salaries of doctors and nurses working within a radius of twenty kilometers of the Swiss border by 20%, where the appeal of cross-border salaries—which can be three or four times higher than Italian salaries—makes it difficult to recruit new staff.

Key facts

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

Details of the salary increase

The economic measure translates into concrete figures for healthcare personnel: a doctor would receive around ten thousand euros more per year, while a nurse's increase would be 5.400 euros. To finance this measure, the councillor for Local Authorities, Massimo Sertori, confirmed the intention to apply the contribution provided for by the 2024 Budget Law.

This levy would affect the so-called “old frontier workers”, residents of Lombardy and workers in Switzerland who benefit from the binary system. The contribution would be calculated as a percentage starting at a minimum of 3%, potentially reaching up to 6% of net income. For example, for a worker with a net income of four thousand francs, the monthly amount payable would be approximately 120 euros. Councillor Sertori stressed that this measure does not represent a “tax on a tax”, but rather an application of fiscal federalism to guarantee essential services in the area and combat depopulation.

Operational details

Analysis of the dual system and vested rights

To understand the impact of this measure, it is necessary to analyze the position of legacy cross-border workers. These workers paid Swiss health insurance for themselves and, until 1999, a payment of approximately 600 thousand lire so that their family members could access the Italian National Health Service (SSN). Subsequently, with healthcare being transferred to the Regions and the Switzerland-EU agreement, the right to choose was introduced.

Comparison of healthcare options

The cross-border worker, within three months, can choose between two distinct healthcare options:

Councillor Sertori explained that, due to a regulatory gap, legacy cross-border workers stopped paying the contribution for access to the SSN. The 2024 Finance Law, promoted by Minister Giancarlo Giorgetti, aims to remedy this situation by introducing a contribution ranging from 30 to 200 euros per month.

The current management of the dual system was defended as the result of a dialogue initiated in 2018 with the Canton of Ticino to overcome the impasse over tax rebates. The objective was to preserve the rights of those who had planned their household finances around certain income until retirement. The agreement was subsequently incorporated into amendments to the Italy-Switzerland agreement, originally dating back to 1974, ensuring continuity of rights for residents of Lombardy who work in Switzerland.

Useful tools for your case

To practically check your scenario within/beyond 20 km, use net salary calculator and tax return guide.

Key points

Application procedures and checks

The Lombardy Region has already begun the operational phase for implementing these contributions. Councillor Sertori stated that the administration is preparing the necessary software applications for collecting the contributions. A critical issue concerns identifying the obligated parties: the list of former cross-border workers is currently held by the Swiss authorities, making direct access to the data difficult for the Italian side.

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

1. Implementation of software applications for calculating the contribution. 2. Request for self-certifications from workers residing in Lombardy and employed in Switzerland. 3. Conducting random checks to verify the accuracy of the declarations. 4. Issuing payment slips based on the percentage of net income (3%-6%).

For those who work in Switzerland, it is essential to monitor their tax and insurance status. Although withholding tax is deducted in Switzerland, access to healthcare services in Italy for Lombardy residents will now be linked to the payment of these contributions, which range from 30 to 200 euros per month.

Those wishing to assess the impact of these deductions on their net salary or compare healthcare costs between the two countries can use the calculation tools available on our portal. It is advisable to periodically check for updates to the tax regulations to avoid penalties related to self-certifications.

For an accurate calculation of your net salary and applicable deductions, use our salary calculator.

Source: ilgiorno.it