The Republic of San Marino is the world’s oldest surviving sovereign state, and in 2026, its healthcare system is asserting its independence more than ever. With the government recently approving the ambitious “New State Hospital” project to modernize the aging infrastructure at Cailungo, the country is transitioning from a localized system to a boutique medical hub.
For the 2 million tourists who visit annually, the reality is stark: San Marino is not Italy. It is a separate country with its own laws, its own hospital, and strict insurance requirements. While Italians enjoy reciprocal emergency care, other travelers often find themselves facing unexpected bills if they treat the border like it doesn’t exist.
This guide is your survival manual. We will navigate the Ospedale di Stato, reveal the private clinics offering hyperbaric oxygen therapy, and explain why you must look for the green cross of a “Farmacia di Turno.”
The Landscape: One Public Giant vs. Agile Private Clinics
To navigate healthcare here, you must understand the centralized nature of the system.
1. The Public System (ISS – Istituto per la Sicurezza Sociale)
- The Hub: Ospedale di Stato (State Hospital) in Cailungo.
- The Reality: This is the only hospital in the country. It handles everything from childbirth to car accidents.
- The 2026 Context: While high quality, it is small. For highly complex cases (like major neurosurgery or severe burns), patients are stabilized here and then transferred to specialized Italian hospitals in Rimini or Bologna.
2. The Private Sector (Poliambulatori)
- The Hubs: Domus Medica, Poliambulatorio Life, and various dental clinics.
- The Reality: These are outpatient centers (day clinics). They are modern, efficient, and often cater to medical tourists seeking dental work or specialized therapies (like trichology or hyperbaric oxygen).
- Benefit: Zero wait times and high-end equipment.
Top Hospitals & Clinics in San Marino: A Deep Dive
We have analyzed the facilities to bring you the most reliable options in 2026.
1. Ospedale di Stato (State Hospital) – Cailungo
The beating heart of Sammarinese healthcare.
- Best For: Emergency Trauma (ER), Acute Illness, and Maternity.
- Why it stands out: It is the only facility with a 24/7 Emergency Room (Pronto Soccorso). If you faint at the top of Mount Titano, the ambulance (118) will bring you here.
- Key Upgrade: In 2026, the hospital is rolling out new digital services via the “Fascicolo Sanitario Elettronico” (Electronic Health Record), improving how fast they can share data with Italian specialists if a transfer is needed.
2. Domus Medica – Borgo Maggiore
The elite private alternative.
- Best For: Hyperbaric Oxygen Therapy, Internal Medicine, and Diagnostics.
- Why it stands out: It houses a certified Hyperbaric Centre with multiple chambers—a rarity for such a small country. It is also ISO 9001 certified. If you need specialized non-emergency care in a private setting, this is the gold standard.
3. Poliambulatorio Life – Serravalle/Dogana area
The wellness and specialist hub.
- Best For: Physiotherapy, Pain Therapy, and Eye Care.
- Why it stands out: Known for its holistic approach, offering services like “Pain Cocktails” (mesotherapy) and advanced rehab. It’s a favorite for residents needing ongoing care without the hospital environment.
4. Il Mondo del Sorriso (Dental Clinic) – Dogana (Atlante Center)
The dental tourism destination.
- Best For: Dental Implants, Orthodontics, and Cosmetic Dentistry.
- Why it stands out: Located inside the Atlante Shopping Center, this clinic aggressively targets international patients with extended hours (often open until 8 PM and on Saturdays). They offer high-quality Italian-standard dentistry at competitive tax-advantaged prices.
📊 Comparison: Top Medical Facilities
Use this table to decide where to go based on your needs.
| Facility Name | Location | Type | Key Strength | Best For |
| Ospedale di Stato | Cailungo | Public Hospital | 24/7 ER | Major Accidents, Chest Pain |
| Domus Medica | Borgo Maggiore | Private Clinic | Hyperbaric Chamber | Oxygen Therapy, Checkups |
| Poliambulatorio Life | Serravalle | Private Clinic | Rehab | Physio, Chronic Pain |
| Il Mondo del Sorriso | Dogana | Dental Clinic | Implants | Dental Tourism |
| Centro Medico Smile | Serravalle | Dental Clinic | Family Care | Routine Dentistry |
| Farmacia di Cailungo | Cailungo | Pharmacy | 24/7 Access | Nighttime Meds |
💡 Real Success Story: The “Border” Confusion
Understanding the insurance rules prevents financial shock.
Case Study: The Forgotten Insurance
The Challenge: Sarah, a tourist from Ireland, twisted her ankle on the cobblestones of the historic center. She assumed her EHIC card (European Health Insurance Card) would cover her fully, just like in Italy.
The Reality: While San Marino has agreements, it is not an EU member. The EHIC acceptance is technically for “urgent” care under specific bilateral terms, but administrative hurdles can occur.
The Solution: The staff at the State Hospital treated her effectively, but she faced a complex paperwork process to prove eligibility.
The Outcome: Because she had Private Travel Insurance, she simply paid the bill (approx. €150 for X-rays and cast) and was reimbursed later.
The Lesson: “I didn’t realize San Marino was a separate system. Having private insurance turned a potential bureaucratic nightmare into a simple receipt scan.”
👉 Confused about the “Italy Reciprocity”? Ask for clarification here: https://www.myhospitalnow.com/forum/
Essential Tips for Patients & Tourists
1. The “Italy Rule” (Reciprocity)
- For Italians: You generally have full reciprocity for urgent care.
- For EU Citizens: Do not assume your EHIC works seamlessly. While you will not be refused emergency care, billing can be complicated.
- For Non-EU (USA/UK): You must have private travel insurance. It is often checked at the border or hotels during registration.
2. Pharmacy Duty Rosters (Farmacie di Turno)
San Marino has state-run pharmacies.
- The Rule: Only one pharmacy is open 24/7 for the whole country: the Cailungo Pharmacy (inside the State Hospital).
- Daytime: Local pharmacies in the Castelli (towns) like Borgo Maggiore or Serravalle are open standard shop hours.
3. Emergency Numbers
- 118: Medical Emergency / Ambulance.
- 112 / 113: Police & Gendarmerie.
- 115: Fire Brigade.
4. Getting There
- No Airport: All medical evacuations or serious transfers happen via road ambulance to Rimini (25 mins) or Bologna (1.5 hours) in Italy.
Frequently Asked Questions (FAQs)
1. Is healthcare free in San Marino for tourists?
No. Unless you are covered by a specific bilateral agreement (like Italy), you must pay. Emergency stabilization is prioritized, but billing follows.
2. Is there a hospital in the Historic Center (Città)?
No. The Historic Center (on top of the mountain) has a small dispensary/clinic for basics, but the main State Hospital is down in Cailungo. You will need an ambulance or taxi to get down.
3. Do doctors speak English?
Yes, generally. Many doctors trained in Italy or internationally. In private clinics like Domus Medica, English is standard.
4. Is there a hyperbaric chamber?
Yes! Domus Medica in Borgo Maggiore has a fully operational hyperbaric center, which is surprising for a microstate.
5. Can I use my Italian prescription here?
Yes. San Marino pharmacies recognize Italian and EU prescriptions. However, you pay the full price; you cannot use Italian “Ticket” copay exemptions here.
6. Is dental work cheaper here?
It can be. Clinics like Il Mondo del Sorriso offer competitive rates compared to major European cities, often with tax advantages that lower the final bill.
7. Is the water safe to drink?
Yes. Tap water is safe and meets EU standards.
8. What is the “New Hospital” project?
Approved in late 2025, it is a plan to construct a modern wing at the Cailungo site to update the 1980s infrastructure. Construction may affect parking in 2026.
9. Are there 24-hour pharmacies?
Only one: Farmacia di Cailungo located at the hospital. Other pharmacies close at night.
10. How do I call an ambulance?
Dial 118. It is the same number as in Italy.
Conclusion: Small State, Big Care
San Marino proves that size doesn’t dictate quality. With a centralized State Hospital for emergencies and elite private clinics like Domus Medica for specialized therapy, the microstate is well-equipped.
However, respect the border. Treat San Marino as a unique international destination—bring your passport, buy your insurance, and know where the Cailungo hospital is before you climb the towers.
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