Monday, April 8, 2013

Italian medical system works, with a bit of patience or extra money

Tuesday, April 9, 2013
I hesitate to even try to write about the Italian medical system, because I know so little. However, that little is probably more than the average foreigner knows, so I will share what I have learned.

Italians receive nearly free medical care provided by the government. I say nearly because there is a small administrative charge for services. And, of course, some could argue that they pay for their “free” services by paying higher taxes, but I’m not about to touch that whole issue. I just want to write about what an Italian citizen can expect to receive in medical services.

Because I have chosen to live in a community where few Italians speak English, I am limited in my contacts. I could poll my Italian-speaking acquaintances, but their answers would have to be simplistic for me to understand. Once they got into the complex nuances of the system, I’d have to start making guesses about their explanations, and I don’t want to chance misrepresenting someone—so I have only talked to the few friends I have who speak English well, which limits my input.

Steve is an imported American who has lived in Italy since 1986 and has become a permanent resident. He recently had some serious issues with a disk in his back, and he went through the Italian system to get treatment. He vented his frustration on his Facebook page, which I quote from:

I went to my designated-by-the-government local doctor and got a prescription to have an MRI. After waiting one hour, I finally got in (sitting on waiting room chairs kills even a good back). By the way, the office is only open two hours a day for the community. I then went home, proceeded to call the place where I get it done and made an appointment for next week (which means lots of Ibuprofen to kill the pain and eat up my stomach till then). They send me a packet of material that my local doctor has to fill out and sign, then I personally have to send it back to the MRI lab.

So yesterday I walked back to my local doctor 30 minutes early so I could be first in line. There’s a note on the door saying the doc will not be in either yesterday or today. However, he left a note on the door to everyone to go see the other local doc in town. It says that she is open from 4 p.m. to 6 p.m.

Great! So, limping to the other office (a half mile), I see there is only a short line (two people in front of me—yes!!). So we stand in line, and 4 p.m. passes. 4:20 passes, 4:40 passes. We note that the sign on her door says for sure she is open at 4 p.m. Finally the lady next to me calls a number and talks with someone to see if the doctor really is alive and coming. They assure her so. Another guy walks up (all of us are from the doc who is closed) and then another guy. We are six now.

Then another one of “our guys” comes, at 4:55, and says to us, “Yeah, I called the office and found that this office really opens at 5 p.m. and that she takes people only by appointment.” Ugh! Ouch! I have been standing now on pavement for more than one hour and 15 minutes, and my back is really killing me!

Finally she drives up at 5:10. We’re all complaining about this horrible social medicine system— and the Italians wish they had the American system. We sit down in horrible chairs again. The doc decides she will alternate between her appointment people and “our” people. The appointment people complain; “our” people complain. Finally, at 6 p.m., I get in, do my thing, having her sign a piece of paper for the MRI (30 seconds) and I walk out.

Steve also included a commentary on how Obama-care will make America more like the Italian system, with more government involvement that increases both costs and delays. He followed up a month later with a post saying that with medication, stretching and prayer, his back was much better. One of his Facebook friends from the Piemonte region made a comment that the system works much better where he lives, and that he received immediate and thorough attention for his back problem.

Here in San Salvatore, Elena thinks the Italian system is excellent, though admittedly very slow. Cousin Mario had to wait nearly a year for knee replacement surgery, but it has been expertly done; he is now back on his feet, and the costs were covered by government. She says the system assigns priorities based on the seriousness of a person’s condition. Those who need immediate treatment are taken care of first, while others have to wait. If people want faster care, they can pay for private services at very reasonable rates.

Another friend, Stefano from Padova, explained that he went to his doctor recently and was prescribed a treatment for a skin condition but told he would have to wait two months and pay the administrative fee of 36 euro—or he could get the treatment the next week with a private payment in the same office and pay 70 euro. He chose the latter because of the small difference in cost and large difference in waiting time.

He says the low cost for private medical treatment is the result of several factors. One is that university education is nearly free in Italy, so physicians graduate without huge debts. It also has something to do with the way the marketplace has developed. A doctor can’t charge a huge fee because the patient can just be a little more patient and wait to get the service for less from the government. I can also imagine that since doctors work for both the government and have private clinics, the costs for initial diagnosis and testing have already been covered by government exams; often all a doctor has to charge for is the treatment.

Trying to make direct comparisons of medical systems between countries is incredibly complicated. Each country has been through different periods of growth and adaptation. Public expectations are different. Tax rates are hard to compare because there are so many different taxes in each country. I think the best I can do as a citizen of both Italy and the United States is to learn how to work within each system, becoming familiar with the strengths, weaknesses and intricacies as best I can. It’s not easy, but if there was an easy solution, then someone smarter than I would have found it by now.

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