So it is a paid program

Payed by your poverty.

If you end up inheriting money from a distant uncle, you have to pay back.

> you can't give away your money for the sole purpose of acquiring government benefits

That's understandable.

And it's only necessary because the country with the highest spending per capita on healthcare cannot agree that the only reason why they don't create a free universal healthcare system is not because it is economically unfeasible (if it is for Italy, it is for USA, I usually argue that USA could do a much better job than us), but because they fear that without the incentive to become rich and distance yourself from State benefits, the system would collapse.

It's only a cultural problem: nobody wants to rely on the State providing base services because nobody wants to think of themselves as "being poor" because only poor people use public services.

When you come from countries where public figures, politicians, presidents, Queens and Kings and even the Pope go to public hospitals, you can't imagine why it should be a bad thing.

You don't need to qualify, you just need to go tot the hospital.

> Ialy does not have universal long-term care for the elderly

That's not the exact picture though.

If you read the document you posted, it clearly says that

"Only 35% of the residential care beds available are public, whereas 43% belong to private not-for-profit institutions and 22% to private for-profit ones (Table 7). The number of elderly persons in institutional care is still relatively low by international standards, being 19.8 per 1,000 inhabitants aged 65 or older."

The key points are

- elderly care in Italy has always been in the hands of religious intitutions, that's what the 43% of private non profit institutions are. (and that is honestly an entirely different can of worms, but a can of worms nonetheless. I could talk about what opus dei does here it for hours ...)

- Italy is an old country, 25% of the population is >=65, most of them are in relatively good health conditions, as the study confirms.

- only 22% of the long term beds for elderly are private for profit, usually they are for richer people, who want to separate themselves from the rest of us.

- in total, on 15 million elderly, only less then 300k are hospitalized and only 60k of them are paying.

- the vast majority of the elders are taken care of at home, if they are not self sufficient, the State gives the family an allowance to take care of them.

- the problem here is the opposite: many try to trick the State into thinking they need monetary help faking disabilities they don have.

Not counting that elders in Italy have pensions, all of them, regardless of the amount of retirement savings (savings here are mandatory, a minimum of 23% of the salary, of course more savings mean higher pensions, but with zero savings people still get a - fairly low - pension) , payed directly by the State, adjusted for inflation, and that we spend around 15% of our GDP in pensions.