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Lucy has her cast checked while in Gig Harbor in February. |
We are
currently in the middle of our second encounter as official members of the
Italian medical system. Last August on a trip in the Alps, Lucy tore her Achilles
tendon before we came to our Montecarlo home in September. I went through a lengthy
process to enroll us in the Italian health care system so that she could go to
a doctor here in Tuscany (see One
more small step). However, it was almost time to leave for Gig Harbor when
we finally managed to see the doctor, so we decided to have the needed surgery
in Tacoma in January.
Following
the surgery, where they took a tendon from her big toe and grafted it onto her
Achilles, Lucy spent five and half weeks in a cast and another two weeks in a
walking boot. She started physical therapy in March, but now we’re back in
Italy. Her therapist in Gig Harbor said it was essential for her to continue therapy
so that she could gain the flexibility and strength she would need to walk
normally.
On Tuesday,
we went to the doctor’s office to make an appointment. We were asked if it was
urgent and said no, so we were given an appointment date of about two weeks
away. At that point, I explained to the secretary that we just needed a
referral to a physical therapist, so she said we could come back that evening at
6 p.m. and wait for an opening in Dr. Fulceri’s schedule.
We came back
a little before 6 p.m. and waited about an hour, while I mentally prepared to
explain in Italian Lucy’s history and condition, but that was unnecessary. The
doctor (he’s actually still in his final year of medical school) said he needed
to work on his English for his coming exams, so my preparations were unneeded. Lucy
explained her situation, and he told us that physical therapy would probably be
covered under the system, but he needed to do a little research and get back to
us the next day.
We received
an email with a prescription the next morning, which we took to the pharmacy
as instructed. By the way, the prescription was in the form of a pdf, with bar
codes that the pharmacist was able to scan, giving all the needed information—a
very efficient and modern system, it seems to me. However, after logging into
her computer, she told us that there were absolutely no openings in all the
province of Lucca within the next 10 days—and if I understood correctly, the prescription
was only valid for that length of time. She said we could go to the regional health
care office in Lucca to see if they could help us, but we got the feeling that
we’d get the same answer there. Instead, since we live only five minutes from
the border between the provinces of Lucca and Pistoia, we decided to drive to
Pescia and try a pharmacy there—but with the same result. The pharmacist was apologetic
and explained that this was a common issue in Italy. She said we could continue
coming back to try again in a few days, but most people just made private
appointments and paid for care instead of waiting.
So the next
day, we decided to go directly to the fisioterapista in Altopascio that
Dr. Fulceri had recommended, and fortunately we were seen immediately. Dr. Francesco
Monachino gave Lucy a quick exam and noted that one of the reasons she was
walking strangely is that her left leg was now a little shorter than her right
leg. He recommended an insert of .5 centimeters, which we were able to purchase
at the pharmacy. Lucy said she noted an immediate improvement in her gait and sensation
of balance.
Dr. Monachino
scheduled two appointments for us, one on Friday and the other on Monday. I’m
writing this shortly after the first appointment, in which the doctor spent the
majority of the session massaging and manipulating Lucy’s foot and ankle. He
said that massaging the tendon was essential to break down and prevent the
formation of scar tissue. He will do more massaging on the next appointment, he
said, and also work on some exercises to improve strength and flexibility.
We were both
very impressed with Dr. Monachino’s knowledge, professionalism and manner, and
we’re also thrilled that we were able to so quickly find a physical therapist
here. Yes, we weren’t able to get one that is paid by the state, but he
actually costs less than we were paying for visits in the U.S.
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It turns out that Lucy's physical therapist, shown here, is actually semi-famous for being the PT of world-renowned race car driver Robert Kubica. |
In fact, the
cost is one of the most astounding parts of the comparison between Italian and
American health care. Dr. Monachino charged 35 euros for a half hour session,
and he said that Monday he will charge the same for a full hour. In America,
with insurance, we had a co-pay fee of $50 per visit. But the real shock came
from looking at one of the EOBs, (explanation of benefits) from our insurance
company. It seems that for each visit, the physical therapy clinic sent a bill
that ranged from $200-300. The insurance company, of course, did not allow the
full amount, instead paying around $80-110. Adding in the $50 we paid, that
means the clinic was receiving about $130-160 for each visit, which lasted 40
minutes.Lucy said
that sometimes each therapist was dealing with two patients at the same time. The
therapist would give Lucy some exercises to do, and then go and work with the
other patient, returning to Lucy after giving the other patient some attention
and then an exercise to work on—so essentially a 40-minute session only
required about 20 minutes of the therapist’s time.
It’s not the
intention of my blog to make value judgments on the differences between
countries. We’re just relating our experiences as they occur and leaving it up
to our readers to draw whatever conclusions. It’s also important to remember
that experiences in Italy vary widely, so what happens to us may be vastly
different than what happens to someone else. However, even with this
disclaimer, I can’t resist noting that our American health care system is
seriously wacked. If we had no insurance, would that physical therapy clinic in
Gig Harbor really bill us $200-300 for 40 minutes of treatment?
On the other
side of the coin, I noted that Dr. Monachino has an undergraduate degree in fisioterapia
from the University of Pisa, and a masters degree in sports fisioterapia
from the University of Siena. He has a 4.9 out of 5 rating in his Google
reviews. Doesn’t that seem to merit fees of more than 35 euros per session? This
could be why in the 10 years between 2005 and 2015, more than 10,000 doctors
left Italy and moved abroad, according to The Italian Insider magazine.
The article, published Feb. 4, 2019, went on the say: “Their departure is a
damaging problem that is increasingly being felt as the National Health Service
continues to lose even more professionals . . . Italy is committed to the
training of excellent health professionals, spending large sums of money and
then gives this heritage to others.”
Having the opportunity
to observe the interesting differences between Italian and American societies
is one of the pleasures of our divided existence. It would be easy to judge or
complain that one country should emulate the other, but I try to avoid doing this.
These countries have developed their societal systems over many years, and
making sweeping changes would be like trying to change the tire on a car while
it’s still moving. I prefer to observe, learn and do my best to adapt to the requirements
of living in each separate world.