Italy's Thermal Spas: 24 Million Estimated Presences, One Official 2019 Count and No Visitor Count at Saturnia's Falls

The national figures come from the industry, and each one measures something different

The national figures in circulation trace back to two sources. The first is Federterme, the thermal companies' federation inside Confindustria. The second is the Unioncamere-Isnart tourism observatory, which presented its estimate at a Rome event on 21 January 2026 at which Federterme's president, Renzo Iorio, spoke.

Federterme's most recent figures are in a memo it filed with the Social Affairs Committee of the Chamber of Deputies on 4 March 2025. The memo was written for an inquiry into the health professions. It describes about 320 thermal companies, an annual turnover of about EUR 1.5 billion, over 15,000 direct workers and about 65,000 jobs in related activity. It gives no data year and no source for any of the four numbers. An earlier Federterme memo to the Chamber, filed on 2 November 2023, gave about 320 establishments in 180 municipalities, EUR 1.5 billion of turnover and 60,000 workers including related activity, all labelled as 2019 data.

Other counts of establishments sit close to that one. Fortune Italia reported 317 establishments operating at the end of 2023, in every region except Molise, in a map made with Federterme's help (11 February 2025). Campania had 95 and Veneto 92, and Tuscany had 22. Avvenire printed 326 establishments on 6 March 2026 without naming a source. The Federterme website says over 320 centres are in operation, 90% of them accredited to the national health service, and that they served 2.79 million clients, 12% of them foreign. The page shows no year for any of these.

The workforce figure is where the industry contradicts itself. In the same Fortune piece, Massimo Caputi, then president of Federterme, spoke of about 60,000 direct workers in the certified thermal system, and the article adds that indirect workers such as restaurant staff come on top. Federterme's own March 2025 memo gives over 15,000 direct workers and about 65,000 in related activity. Its 2023 memo used 60,000 including related activity. The two filings to Parliament are the more formal source, so we use 15,000 as the direct figure. The documents do not reconcile Caputi's 60,000 with it.

The Isnart release adds the visitor side. It estimates 24 million tourist presences in thermal localities in 2025 and what it calls direct turnover (fatturato diretto) of over EUR 5 billion, of which EUR 3 billion came from international visitors. In Italian tourism statistics, presenze normally means nights spent, but the release does not define the word. The EUR 5 billion splits into almost EUR 2 billion for lodging and food, EUR 1.9 billion for thermal, wellness and leisure services and EUR 1 billion for shopping. Those three items add up to about EUR 4.9 billion, a little short of the headline. The breakdown shows the figure is visitor spending across a whole local economy. Spa businesses take a share of it. Treating EUR 5 billion as the turnover of the thermal sector, as some coverage does, overstates the sector by a factor of about three against Federterme's own EUR 1.5 billion.

The release also describes the visitors. About one in two counts as a high spender, at EUR 256 a day, about EUR 90 more than the average thermal tourist. Six in ten are repeat visitors. No sample size, survey period or method appears in the release, and we did not find a full report online.

ISTAT counted thermal towns once, and we found no official count of the spas

ISTAT does have a thermal category. It appears in the classification of municipalities by tourism density that ISTAT produced under Law 77 of 17 July 2020, published on 19 January 2022 with 2019 as the reference year. A municipality counts as thermal if it was defined as thermal in the last official map of tourist districts, supplemented with the list kept by ANCOT, the national association of thermal municipalities. ISTAT calls it the smallest category. It holds 50 municipalities, 0.6% of Italy's population and 1.2% of its tourist presences. Its table gives 5,093,035 presences in those 50 municipalities in 2019, out of a national total of 436,739,271.

That figure is official, but it has limits. It covers one year, and the document does not promise an update, saying only that the method allows comparison over time. It counts presences in municipalities, so a spa hotel and an ordinary hotel in the same town land in the same total. It cannot be set beside Isnart's 24 million as a trend, because the two use different lists of places and different years. Tuscany shows how far definitions drift. ISTAT classes 7 Tuscan municipalities as thermal, and IRPET's regional study uses 12.

ISTAT's monthly accommodation statistics, the series Italy reports to Eurostat, have no thermal category. We did not open the Eurostat tables for this article and found no thermal series in ISTAT's catalogue. The Ministry of Health publishes no national count of accredited thermal establishments that we could find. We found no national count of patients treated under the health service, of treatment cycles delivered or of public spending on thermal cures. We found no count from INPS, the pensions and welfare agency, of people whose thermal cures it funds.

The law explains part of this. Law 323 of 24 October 2000, the framework law for the sector, defines thermal waters, cures, establishments and thermal territories, and it sets how the health service pays for cures. On data, its Article 6 says only that the Health Minister may promote the involvement of thermal companies in statistical and epidemiological surveys. The duty is voluntary. A quarter of a century later the sector is still measured mainly by the federation that represents it.

Tuscany is the one region with a study, and it rests on 2019

IRPET, the Tuscan regional institute for economic planning, published the only regional economic study of thermal tourism we found. Nota rapida number 18, edited by Nicola Sciclone, is dated February 2023. It takes the 12 Tuscan municipalities with thermal establishments that, in IRPET's words, ISTAT classes as thermal on the basis of the prevailing tourist resource. It excludes places where seaside or art tourism dominates, such as Portoferraio, Massa and Montepulciano. Manciano, which contains Saturnia, and San Quirico d'Orcia, which contains Bagno Vignoni, are on its list. So are Montecatini Terme, Chianciano Terme, Bagni di Lucca and Rapolano Terme.

Those 12 municipalities recorded 3,528,543 nights in official accommodation in 2019, against 3,492,210 in 2005 and 3,630,356 in 2013. The study says this was 6.9% of all nights in the region's official accommodation. Its table gives 51,345,681 nights for Tuscany in 2019, and the share checks out against it. Elsewhere the text gives about 5.8% of official tourist flows without naming the base. The 6.9% has a stated denominator. The 5.8% does not.

Manciano had 188,257 nights in 2019, 5.3% of the thermal total. San Quirico d'Orcia had 184,959, or 5.2%. The two towns moved in opposite directions over the longer run. On IRPET's figures, Manciano's 2019 nights were about 2% below 2005, and San Quirico's were about 45% above (our arithmetic from Tabella 4).

IRPET estimates that thermal towns drew EUR 388 million of tourist spending. It models that this spending activated EUR 304.8 million of regional GDP, about 0.3% of the total, and about 6,300 jobs once direct, indirect and induced effects are counted. The text calls them jobs, while the table title counts full-time equivalent work units, so the 6,300 is best read as full-time equivalents.

The model also breaks the effect down by local labour system, ISTAT's commuting areas. San Quirico d'Orcia falls in the Montalcino system and Manciano in its own. The Manciano system shows EUR 9.6 million of GDP from thermal tourism, about 240 work units and 5.5% of its GDP. The Montalcino system shows EUR 11.6 million, about 230 work units and 2.6% of its GDP. Montecatini Terme dwarfs both, with EUR 112.2 million and about 2,560 work units.

The study also gave a first reading after the pandemic. In the first eight months of 2022, Tuscany's thermal municipalities were about 24% below 2019, against 15% for the region as a whole. For 2022 as a whole, estimated from those months, the large thermal cities were 30.9% down on 2019 and the smaller wellness centres 11.8% down. No later IRPET thermal update was found. The Region's 2025 tourism release (updated 21 May 2026) says only that thermal localities continue a slow contraction under way for years, and gives no figure. For the region's own totals, which are published in two versions with and without short-term rentals, see our Tuscany tourism statistics. Neither version has a thermal line.

Saturnia has a resort that reports results and a free cascade with no published count

Saturnia is two economies a short distance apart. One is Terme di Saturnia Natural Destination, a resort with a hotel, a thermal park and a golf course. The other is the Cascate del Mulino, the free terraced pools on a stream below the village.

The resort is the only thermal business in this article that reports numbers. Its 2025 figures appeared in Milano Finanza on 10 July 2026 and in the trade title Quality Travel on 7 July 2026, in interviews with general manager Antonello Del Regno. Revenue was EUR 28.2 million, about 10% up on 2024, the best in its history according to Milano Finanza (Quality Travel says its recent history). It sold 31,600 rooms, hosted over 60,000 guests and served over 110,000 restaurant covers. Quality Travel adds over 105,000 entries to the thermal park and club and about 250 direct staff. The company plans EUR 15 million of investment in 2026 and 2027 and aims to pass EUR 35 million of revenue by the end of 2027. None of this comes from filed accounts we could see. These are company figures passed on by the press.

One of them does not add up. Quality Travel gives 2019 revenue of EUR 16.5 million and growth of 64% since then, at an annual rate of 8.6%. EUR 28.2 million against EUR 16.5 million is a rise of about 71%. The 64% and the 8.6% agree with each other and imply a 2019 base nearer EUR 17.2 million (our arithmetic). The article does not explain the difference.

Milano Finanza reports that the resort belongs to Massimo Caputi and sits within his group Terme & Spa Italia, alongside Terme di Chianciano, Monticello The Entertainment Spa and Terme De Montel Milano. Caputi led Federterme until late 2025. Renzo Iorio succeeded him, according to a QdS report of 20 December 2025, and Iorio spoke as Federterme president at the January 2026 Isnart event. For travellers comparing a stay, the resort and other spa hotels appear in our guide to where to stay in Tuscany.

Down the road, the record is thin. The only public acts we found for the Cascate del Mulino concern parking. In early April 2023 the Comune di Manciano started charging for its temporary car park for the falls, at EUR 2.50 an hour for cars and EUR 4 a day for residents and hotel guests, from 8:00 to 20:00. MaremmaOggi published that tariff on 5 April 2023. We did not verify the current tariff. In late January 2025 a mayoral ordinance closed the temporary car park for two months, GrossetoNotizie reported, and said the lot had been opened to deal with public safety problems and was meant to run ten months a year. On 27 March 2026 the car park reopened. Il Giunco reported the Comune's stated aim as better regulation of parking and traffic next to the falls, calling the site one of the most visited places in the area without a figure.

None of these items gives a visitor count, the number of parking spaces or the ownership of the land around the pools. We found no access limit, ticket or bathing ordinance. The Comune's own website blocked our requests, so its notices may hold details the press left out. Wikipedia gives the spring's yield as about 800 litres a second with no citation, and its temperature as about 37.5 °C, citing a 2022 book on thermal bathing. We found no hydrogeological source for either figure. The bigger Tuscan picture, including Saturnia's place on a southern loop, is in our Tuscany travel guide.

Bagno Vignoni is a square you cannot bathe in, inside a landscape listed for other reasons

Bagno Vignoni, a hamlet of San Quirico d'Orcia in the province of Siena, has a stone thermal tank in place of a main square. Visit Tuscany, the regional tourism portal, says plainly that bathing in it is not possible. We found no ordinance, date or stated reason for the rule. The same page names three hotels that use the water. Below the village, the Parco dei Mulini holds mills cut into the rock, which the steady thermal flow kept turning in summer.

We found no visitor numbers for the hamlet. San Quirico d'Orcia's 184,959 nights in 2019 cover the whole municipality and every kind of guest. Its local labour system's EUR 11.6 million of thermal GDP is a model output for a wider area that includes Montalcino. We found no act of the Comune on access, crowding or parking at the square. Readers planning a base in the province can start with our Siena travel guide.

Bagno Vignoni lies inside the Val d'Orcia, inscribed on the World Heritage List in 2004 as a cultural landscape (reference 1026, decision 28 COM 14B.51, criteria iv and vi). UNESCO's description covers a managed agricultural landscape of 61,188 hectares with a buffer zone of 5,660 hectares. It does not mention Bagno Vignoni, thermal springs or baths. The springs sit inside a listed landscape. They are not themselves the reason for the listing, and the hamlet is not a UNESCO spa town. The same care applies to any claim that the listing raised visitor numbers. Our Dolomites tourism statistics piece found only one statistical study of a World Heritage listing effect in Italy, and could not judge from it how much the listing itself caused.

The law pays for cures and asks for no data

Law 323/2000 is titled Riordino del settore termale, the reorganisation of the thermal sector, and was published in the Gazzetta Ufficiale on 8 November 2000. Article 2 defines thermal waters as natural mineral waters under a royal decree of 1919, used for therapeutic purposes. It defines thermal territories as municipalities with one or more mining concessions for such waters. Article 4 has the Health Ministry list the conditions for which the health service covers thermal cures, and leaves the rest to agreements between the Regions, the Ministry and the national thermal associations, ratified by the State-Regions Conference. QuiFinanza reports that the health service generally covers one cycle of cures a year for a listed condition.

The current agreement covers 2025 to 2028. QuiFinanza reported on 6 June 2026 that the State-Regions Conference had approved the proposal. Maximum tariffs stay unchanged in 2025 and 2026 and rise 2% a year in 2027 and 2028. Regional spending caps stay at 2024 levels in 2025, may rise by up to 5% in 2026 and then hold. The report said final clearance from the Health and Economy ministries was still pending. Per-session tariffs run from about EUR 4.80 for inhalations to EUR 29.03 for mud with a therapeutic bath. We did not open the primary agreement. Neither the report nor any document we found gives the national total of cures paid for or of public spending on them.

Reform has been on the table for years. A 2013 Senate bill, number 606, proposed amending the law. Its preamble gave 378 establishments in 170 municipalities, EUR 3 billion of turnover, of which EUR 800 million from health services, and over 60,000 direct and indirect jobs, with no source. A Senate bill in the current legislature, communicated on 3 July 2024 with Senator De Poli as first signatory, would repeal Law 323/2000 and replace it. Its explanatory report contains no statistics. Gian Marco Centinaio, vice-president of the Senate, presented a thermal tourism bill at the January 2026 Isnart event. We did not establish the progress of either bill. Federterme's March 2025 memo notes that the law's Article 9 profile of the thermal operator has never been put into practice.

UNESCO lists one Italian spa town, and it is Montecatini

The Great Spa Towns of Europe joined the World Heritage List on 24 July 2021, at the 44th session of the World Heritage Committee, held online and chaired from Fuzhou (reference 1613, criteria ii and iii). The property groups 11 towns in seven countries. Montecatini Terme is the Italian component, alongside Bath, Baden-Baden, Vichy, Spa and the three West Bohemian towns. Saturnia and Bagno Vignoni are not part of it. Any claim that Italy has no listed spa town is wrong, and so is any claim that Tuscany's hot springs are on the list.

Montecatini is also the largest single block in IRPET's model, with EUR 112.2 million of thermal GDP in its labour system in 2019, more than a third of the Tuscan total. La Nazione reported on 1 January 2024 that the town's historic thermal company had been under a court-supervised creditor arrangement since July 2023, with only the Redi establishment open. We did not check its current status. The UNESCO listing records the town's architecture and history as a spa resort. It says nothing about how many people use the baths today.

What this means for travelers, businesses and analysts

Travelers should treat the published rules at the free springs as the facts that matter, since we found no count of the crowds. At Saturnia, the parking arrangements have changed three times since 2023, and the stated tariff dates from April 2023. At Bagno Vignoni, the regional portal says the square's tank is for looking at, and the hotels around it hold the bathing water. We found nothing official on how busy either place gets or when. The thermal localities' high season is not measured either, so any claim about the quietest month is a guess.

Tourism businesses and investors have no official denominator for a thermal market study. The national figures for establishments, turnover and jobs come from the federation that represents the operators, and its own direct-jobs figure ranges from 15,000 to 60,000 depending on the document. The only modelled local economics are IRPET's for Tuscany, on a 2019 base, before the pandemic and before the region's short-term rental boom. Company results such as Saturnia's EUR 28.2 million are useful benchmarks, but they reached us through the press, and one of the growth figures attached to them does not reconcile.

Journalists and analysts can cite, with their labels, ISTAT's 50 thermal municipalities and 5,093,035 presences for 2019; Unioncamere-Isnart's 24 million presences and over EUR 5 billion of visitor spending for 2025, as estimates; Federterme's about 320 thermal companies, about EUR 1.5 billion of turnover and over 15,000 direct workers, as association figures with no data year; IRPET's 3,528,543 nights, 6.9% share, EUR 304.8 million of GDP and about 6,300 full-time equivalent jobs for Tuscany in 2019; and UNESCO references 1613 (Montecatini Terme, 2021) and 1026 (Val d'Orcia, 2004). Do not repeat EUR 5 billion as sector turnover, 60,000 as direct jobs, 400 companies, EUR 11 billion, 380 sites, EUR 15 billion of indirect impact, the 5.8% Tuscan share or 64% growth at Saturnia, and do not quote any visitor count for Saturnia's falls or Bagno Vignoni, because we found none.