After I had gone to the courthouse to get married. After the signed documents and a visit to the US embassy. After I had gone to dozens of public offices and was finally a legal resident of Italy, there was still a very important document I needed to obtain. ASAP, they told me.
I needed my Tessera Sanitaria, Italy’s national healthcare card
It has all your personal identification info on it but most importantly, it’s what permits you to use the Italian healthcare system.
Italy has a government-sponsored healthcare system which means that most things are free or heavily subsidized.
You can lecture all you’d like about your preferred form of healthcare, but in the end you use the healthcare you have. And so as a newly minted resident of Italy, that’s exactly what I did.
Here are some of my own experiences navigating the Italian healthcare system as an outsider:
I had been pregnant about a day when the essential existential question was raised: Will you go public or private?
See, though the Italian healthcare system is publicly run, there’s an entirely separate yet parallel healthcare system operating in the shadows: the private system. Anything you could need from a primary practitioner to a surgeon you can access by, of course, paying.
If you are sick you go to the doctor and show your national healthcare card and don’t pay a thing. If you need a specialist, however, you can expect to wait. To avoid waiting, you can go private.
Most Italians use a mix of the two: public for certain small, fast things as well as major surgeries and private for more pressing issues or certain specialists like the dentist, eye doctor or gynecologist.
Most of the women I know go to a private gynecologist, as its the only way to get a timely appointment and ensure you’ll get the same doctor for each visit. Because of that, many often continue seeing their OB-GYN during pregnancy up to the delivery, despite the higher bill.
I didn’t have a gynecologist in Italy yet, so I went public. I happened to see the same doctor at every visit (though a different nurse for the ultrasounds and a different doctor at my four-month post-labor check up) and had multiple different nurses in the room with me during labor. The doctor I had seen during visits was not the one who delivered Adeline, and but I can tell you that by that time I didn’t particularly care who was down there.
Every single visit to my primary practitioner is free. Most of the medicine is heavily subsidized. For the first time in my life I started to see my doctor before I developed full-blown bronchitis. I started to value preventative care.
Encouraged, I started to investigate my foot pain by going to my primary doctor. She sent me to the local hospital’s clinic for x-rays and a visit with the podiatrist.
Once there I took a number and waited to be called, the only way that Italian hospitals seem to work. Then fixed an appointment at that very same hospital for the following week. I also had to pay a “ticket,” a relatively low fee required for certain types of tests or care. In my case it was 28 euro for the x-rays and visit.
Once visited, the doctor suggested that a minor intervention to fix my bunion would be sufficient, but that it’s not pressing, so on the list for ordinary folk I went, to wait for the “phone call”.
Care in Italy is divided into two lists: urgent and not urgent. If you’re not urgent, like me, you risk to wait 6 months to a year before being called in for surgery.
In my case I could wait, but I hated not being able to plan ahead of time.
See, once upon a time everyone in Italy had a job contract. They had worker’s rights and so many protections that employers stopped hiring people. If they had to have surgery they had to have surgery and they’d be paid the entire time they were out on sick leave thank you very much.
I don’t have that kind of job and I don’t know many people my age who do. Some of us are paid hourly and some of us might lose our job if we’re all of a sudden not around for a month or so and some of us would prefer surgery at a specific time of year. (Like summer, for us teachers). Instead, you wait for the phone call.
The phone call is the dreaded call that you can get at any point in time saying “we’re ready for you – surgery next week!”
In my case, they called me in October, roughly 6 months after my first visit and I had to turn them down.
If you say no more than once you have to start everything over again from zero. When they called me in April, I said yes.
So back to the hospital I went for pre-screening tests. I was instructed that my appointment was at 9:30. They didn’t tell me that “appointment” just meant “time you can come to request a number and wait.” I waited two hours or so to be processed, then another two hours to go through the tests: an EKG, blood test, visit with the doctor and visit with the anesthesiologist. Nearly four and a half hours later I was finally home free.
My neighbor is a cleaning lady. When they found cancer in her breast she got treatment. She got ultrasounds and x-rays and MRIs and surgery and chemotherapy and visits on visits on visits. They saved her, and she didn’t have to pay a thing.
What would have happened to her if she lived in America?
When I was pregnant the first question Italians asked me was, “will you give birth here or in America?” I thought it was just about the stupidest question I’d ever heard.
I live here. I work here. I have no insurance in America.
Though the World Health Organization ranks Italy in the top 10 countries for quality healthcare, it’s far from perfect.
It’s well-known that most people from the south with any means will come up north to get care, as the hospitals lack the most basic equipment, from tools to bandaids. Often you’re expected to bring certain items with you for surgeries because the hospital won’t supply it. Public hospitals are often overcrowded and underfunded. With a two-tiered public/private system, most of the best doctors in Italy work for the private system because they can. They charge more than government prices and the customer pays the difference. In the meantime, insecurity in certain healthcare specializations in the public sector rises. Though Italy believes in healthcare for all, it’s often the wealthy that have the best options.
And when the former Italian Prime Minister Silvio Berlusconi needed cardiac surgery, he chose to do the operation at the Cleveland Clinic, USA.
I was admitted to the hospital the night before they planned to break my water. With a traumatic labor (their definition, not mine) I had multiple nurses monitoring me. They saved my baby and avoided a C-section. After, I stayed the normal three nights post-labor and went home with zero transactions.
I stayed overnight for my foot surgery as well. The doctors and nurses were kind, attentive and professional. The next day I hobbled my way to the car with a smile and a wave and nary a bill.