Getting sick in Italy. Nothing to worry about.

August 10, 2015

prontosoccorsoThere is no particular reason why you should get sick in Rome, or anyplace else in Italy for that matter. The drinking water is fine, in some places like Rome it is delicious. As we know, Italian food is generally both luscious and healthy, although it may be wise to be wary of the fast food places that are springing up like weeds. And yes, there can be smog in some major cities. So what else is new? But, of course, you can get sick anywhere, or else have an unexpected health problem, like a detached retina or a sprained or broken ankle. So what do you do?

I hear tell that many Americans opposed Obamacare, the closest thing the US has ever had to a national health service, on the grounds that national health is a “commie” idea. Balderdash! Most of Western Europe has long had national health plans and it is something that I think most Americans would be overjoyed to have, if they knew what it was. In fact, precisely because Italy has a national health service, you as a tourist (foreign residents have a health service doctor they rely on for primary treatment) can get treatment at a  hospital emergency room – the relevant term here is pronto soccorso – and almost certainly you will not have to pay anything. (Recently, the Italian health ministry decided to apply a €25 charge to dissuade Italians over 14 and under 65 years of age from going to the pronto soccorso for minor ailments instead of going to their health service doctors.  But no tourist in his or her right mind is going to waste precious time for a mere sneezing fit or a low grade fever and anyway Italian bureaucracy isn’t set up to charge non-resident foreigners.)

The negative side is that at an Italian pronto soccorso you may have to wait quite a while, although from my own personal experience I have never waited as long as here in Italy as I did some 20 years ago when I went to the Beth Israel emergency room in New York for a dislocated toe!

pronto soccorsosalaattesaWhen you go to an emergency room in Italy you are given a color classification: the official triage plan sets code red (codice rosso) for a real emergency, codice giallo (code yellow) for semi-emergencies,  green for cases that are poco critico, that is, not really critical, by which they mean the condition is unlikely to develop further and is not at all life-threatening. A sprained ankle would fit into this category. Codice bianco, code white, is for something that is not very important at all and, if you are Italian, perhaps someone from another city who doesn’t feel well and doesn’t know where to go, a visit to a pronto soccorso could cause you to incur the €25 fee mentioned above, that is if you actually have the patience to wait long enough to see a doctor. Understandably, red cases are taken first, yellows follow and it may take a while to get to the greens.

My suggestion is that if you turn out to be a code green − unless you something like a sprained ankle and cannot walk − you might want to leave and go to a pharmacy and ask the pharmacist’s advice on what you should take. Another way around the waiting problem is to go to the pronto soccorso late at night or very early in the morning when you may get taken more quickly. On yet another occasion when that darn toe got dislocated (subsequently, an Italian orthopedist to whom I will always be grateful did something to it in a minor operation and it never got dislocated again!!!), I went to the pronto soccorso at dawn after a sleepless night and although I was a green – no life risk there –received almost immediate attention.

By the way, if you are really sick or break a leg, remember you can call 118 and an ambulance will come and take you (free of charge) to the nearest hospital). A good friend of mine was forced to do this when he suffered acute gastric pains during the night in his Orvieto hotel. He was taken to the emergency room, and given all sorts of tests – it turned out to be an overdose of anti-inflammatories – and then admitted to the hospital where he was put on an IV and kept for three more days, with – he says –excellent and attentive care. As I said before, both the emergency room and the ambulance cost nothing. When he was released, he gave them his U.S. insurance card but I am betting that he never gets a bill.

If, instead, of going to an emergency room, you want to go to a private doctor, where you definitely will have to pay, finding one is not going to be hard. There are plenty about. The consulates of most countries have lists of doctors that speak their national language. The Internet also is a great resource for searching for things like English-speaking doctors in Milan, Rome, Venice, Florence etc. At the walk-in clinic run by the Knights of Malta in Via Bocca di Leone smack in the center of Rome, you are bound to find a doctor who speaks some foreign language. And whatever doctor you go to, especially in a major city, you are more than likely to be satisfied since In my 40 years of experience, I have found Italian doctors as a group to be as good as doctors anywhere else.

prontosoccorsocrowdedWhen I first lived in Italy, back in the 1970s, I used to think that if I ever got seriously sick, I would head back to the U.S. But today, I don’t feel that way at all. Although fortunately for me, I have never had any major diseases, the specialists I have consulted here – ENT, orthopedists, phlebologists, cardiologists, gynecologists, breast surgeons – have all been top notch. Regrettably, the same cannot be said about many Italian hospitals, although up north – particularly in the smaller cities – the situation might be better than in Rome and down south. Italian hospitals are public and alas – but this is a general problem in Italy – they suffer from the same lack of funds, waste, and rampant disorganization as many other Italian public institutions. Some of the ones I have been to are not even that clean. A private hospital is called a clinica, but although cheap by US standards (what isn’t?) they are expensive and generally do not have a full range of surgical departments.

Italians tend to complain a lot about their national health system: in many areas of the country there are long delays in getting certain kinds of tests, although the existence of an entire sub-strata of private diagnostic centers that are affiliated − convenzionati − with the SSN and therefore recognize their referrals and apply its prices does make things easier. And, of course, if necessary one can always have a test privately, and pay for it.

But I think it is enviable. Not so long ago an Italian friend, Marcello, who is over 65 and who lives in a town near Viterbo in central Lazio, had a hip replacement and three weeks of physical therapy at a structure outside of Florence and paid nary a dime. Claudio, the jeweler across the street from my building in Rome, had emergency open heart surgery after a leaking valve was discovered and naturally it was free. Nicoletta, 34, just had a vein stripped at an Orvieto hospital, again, with only a minor payment. Another friend had a diseased toenail removed gratis, while I did it privately and paid 1000 euros, (although I did get around 700 euros back from my private insurance).

PRIVATE INSURANCE

Increasingly, Italians who can afford it have been buying complementary private health plans: once upon a time, the entire national health system – including pharmaceuticals – was totally free for Italian citizens but over the years a series of co-payments have been added (this is true in most European countries, including Sweden which once prided itself on its generosity but has now, too, had to come with the costs incurred by aging populations and costly equipment). This, and the long waits that exist in some parts of the peninsula, have led those who can afford it to buy into some kind of private plan. Me, I have one because as a member of the Italian journalists union, I had to sign on to their plan, Casagit, for which I paid (and it wasn’t cheap) out of my salary. Now that I am retired from the newspaper, I get the same plan for the equivalent of $110 a month and consider myself very, very lucky.

But this doesn’t mean I don’t use the SSN. I do, and quite happily most of the time. I needed a dermatological cream for a pre-cancerous skin lesion that if purchased privately with a private doctor’s prescription could have cost me considerably, something like 90 euros. Unfortunately, it turned out that even Riccardo, my health service doctor (every resident needs to be on n SSN doctor’s list, which shouldn’t number over 1500 patients) also couldn’t write the prescription. I needed to get it from a dermatologist from the public sector, which meant that what I needed from him was a referral on the official red-trimmed form that I would have to take to an ASL –  an Azienda Sanitaria Locale − a sort of HMO.

Then I remembered about San Gallicano, a dermatologica hospital only a few blocks from my home in Trastevere. Armed with Riccardo’s impegnativa, I showed up at 8:15 at the S. Gallicano clinic in Via delle Fratte di Trastevere 52 and, having been given a number, took my place among a crowd of prospective patients, a hugh number of whom were black Africans, clearly from Sub.Saharan Africa who did not seem to speak any Italian. Turns out that the structure I was in, has now been renamed and has become an INMP (National Institute for the promotion of the health of the Migrant populations and for the struggle against diseases caused by poverty etc etc etc.)

After various bureaucratic procedures,  I coughed up 29 euros and change for the doctors visit. Next, upstairs to a waiting room until a doctor appeared who called my name.  Turned out she thought the lesion could be removed more effectively with liquid nitrogen (criotherapy). Well, when can we do that, I asked? Now, she replied. Writing out yet another impegnativa, she sent me back to the cash desk where I paid an additional fee of 34 euros. A half an hour later I was back in her office, the lesion was burned off and at the moment it seems unlikely to return.

 

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