Tag Archives: hospital

My experiences with the Italian Health System

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When Jim and I started seriously considering moving to Italy, we investigated the Italian health system. It is as different from America’s as you can get…  The Italian constitution states that “The Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent.” And we learned that Italy has a highly rated medical system – second in the world, according to Wikipedia! I want to use this blog post to share my personal experiences with the medical system, including my recent Total Knee Replacement surgery. No pretty pictures in this blog post…

Year 1 (and 2!) – Private Medical Insurance

We applied for Elective Residence Visas to allow us to move to Italy. One of the many requirements was to show that we had Private Medical Insurance because the Italian Government recognizes that there are many actions that must be taken before new immigrants are eligible to become part of the Italian health system. During a pre-move visit, we signed up for a plan that covered major and unplanned medical expenses – similar to what we would call catastrophic coverage in the USA. The coverage values seemed low to us (€30000 each) but our lawyer said that it seemed adequate to him. The annual cost was €1614 for both of us. We expected not to use the insurance, but unexpectedly Jim needed hernia surgery. I wrote about this experience in one of my earlier blog posts. We had to pay all costs at the hospital but the insurance reimbursed us for all of it! Because of COVID, we still weren’t able to sign up for the Italian medical system as our insurance was getting ready to expire. We renewed the policy and used it one other time, with the same results – all costs covered with no deductibles. During this period, we paid the full cost for our prescription medicines, but they cost us less than half of the co-pays that we had in America with our health insurance.

Participation in the Italian Health System

Once we became official residents, we were able to sign up for the Italian Health System and received our coveted Tessera Sanitara cards. We had read many places that this insurance is “free” but also read that there were costs involved. It turns out that the Constitution and the laws state that it is “free” but with the kind of visa that we have, we were required to make a voluntary contribution for the insurance. LOL! The first of many bits of confusion regarding the Italian Health System. We pay €2788 per year for this “public” insurance.  We selected a primary doctor that speaks some English and has an office close by.

Working with our primary doctor

I don’t actually visit our primary doctor frequently. After my initial visit and a review of my medical histories, he provided prescriptions for my regular medications and encouraged me to use WhatsApp to send further requests to him. So, whenever I need a prescription for medicine, a referral for a special visit, or a medical test, I simply send him a message with WhatsApp. He writes the prescription and leaves it at the pharmacy in his building and I pick it up that day or sometimes the next. Very easy and efficient but a bit impersonal! Many prescriptions cost nothing, some have a co-pay up to €20.

When it is time for a visit to our primary doctor, I send him a message via WhatsApp and he tells us when to come. Usually that day or the next. When you enter the waiting room for several doctors, you simply ask the group of people waiting “L’ultimo per Dottore Morotti” or “Who is the last person waiting for Doctor Morotti?” Someone should acknowledge that they are the last and you sit down and wait your turn; you need to remember who was last, so that you can enter the doctor’s office after that person finishes. When the next person enters the waiting room with the same question, you acknowledge that you were last and they now know where they fall in line. When the doctor is ready for the next patient, he simply appears at the door and says “Chi è il prossimo?” or “Who is next?” This sounds like a wonderful and informal approach, but seldom works as smoothly as it should. They typically are confused by my pronunciation and there are often disagreements about who is actually last or next. This approach is so characteristic of the Italian culture… I giggle to myself every time I watch it in action.

Once it is your turn and you are in the doctor’s office, you share your questions, requests, concerns, problems. There is no nurse, no unnecessary blood pressure readings or weigh-ins and frankly I can’t remember him actually examining me.  He fills out needed forms and prescriptions and hands them to you.  At the end of any visit to a doctor, they give you a one-page summary of the results. You wait while they type and print it or simply hand write it. The doctor may keep some records for their patients but the expectation is that you maintain your own records. There is no charge to see your primary doctor. Once I needed to pay to have a specific form completed and I had to pay €50 for the administrative costs. He took out his credit card machine and I gave him a credit card… no billing department needed! A specialist visit typically requires a payment of around €30.

Working with a private orthopedic doctor

When my knee started hurting in November 2020, we still weren’t covered by the Italian Health System so I went to a private doctor. Once we were covered, I continued to see the same doctor as I had a lot of confidence in him. His office is run a little closer to an American doctor’s office. He has a receptionist who checks you in, accepts the payment, and schedules appointments. This doctor speaks some English and his receptionist speaks English very well.  During an early visit he reviewed my Xrays and MRIs and said that my right knee was in terrible shape. I would need a total knee replacement within a year or two. I was definitely in pain but had no idea that my knee was so bad. Jim had struggled for years with his knees and visited the same doctor. The doctor said that mine was much worse and I would “get to go first”. My initial visit was €130 and included a cortisone shot.

The cortisone shot helped a lot and I was back to walking the streets and wall of Lucca pain free. About six months later the pain started to return and we were getting ready for Derek and Dani’s visit to Italy. I had plans for lots of fun activities and did not want to be in pain for their visit! I returned to the doctor and got a second cortisone shot (only €50 this time) and was pain free again. The doctor indicated that I should plan to have knee surgery in 2022. But the bad news was that the cortisone shot lasted only about a week… After an exchange of emails, we targeted February 2022 for the surgery. I was in pain during their visit and skipped a few of the activities, but it didn’t stop me from enjoying my time with them.

Surgery – private or public insurance?

We had planned to use our private medical insurance because the doctor is a private doctor. But then we learned that we could not renew the same private medical insurance policy because we were now residents; that kind of policy is only for non-residents. So, we asked our insurance company for a similar policy for residents. Bad news, cost was higher and all pre-existing conditions were excluded. I had heard horror stories about people waiting many months for knee operations using the public insurance and was in too much pain for that. I visited my primary doctor to ask how long it would take to get a public orthopedic doctor and get the surgery scheduled. I explained my situation and he confirmed that my orthopedic doctor was the best in Lucca and said that he would certainly accept my Tessera Sanitara (i.e., the public insurance) for my surgery. Another moment of confusion – could my private doctor use the public insurance for the surgery??? I contacted my doctor and waited anxiously for the response. Of course, they would accept the Tessera Sanitara. Certainly no one would be expected to pay the full cost of the surgery! Confused but happy!!!!

Time for surgery – Total Knee Replacement

I won’t provide the full story of the surgery and recovery. If you are familiar with this surgery, you’ll know that it is particularly painful and a difficult recovery. Instead, I’ll provide a list of some of the similarities and differences between an Italian and American hospital visit:

Different – my hospital is a 9-minute walk from my apartment… if I could walk that far. It likely took Jim 12 minutes to drive there…

Similar – pre surgical tests and meeting with the anesthesiologist scheduled a few days before surgery

Different – bring your own crutches, pajamas (no gowns provided!) and all toiletries

Similar – bland food. Even the pasta.

Probably similar – no visitors because of COVID

Different – minimal pain meds. I received intravenous acetaminophen (Tylenol) several times a day. When the pain got bad, I insisted on a stronger pain medicine and received “something like” morphine. Two times.

Similar – high quality staff (doctors, nurses, aides, therapists, etc.).

Different – 6 nights in the hospital versus 0-2 in America

Different – cost for doctors, surgery, hospital, Xrays, physical therapy in hospital, etc. was €0.

  • worst breakfast ever…
  • not sure what the meat was… instant mashed potatoes. I ate the pasta – it was bland but edible.
  • basic hospital room for two people

Recovery – Total Knee Replacement

From the moment I heard the word “surgery” I started worrying about all of the steps in our apartment. We live on the 3rd, 4th, and 5th floors (with the ground floor designated as zero). There are two different sets of stone steps before reaching the elevator then once you reach our apartment, we have four more sets of stairs. Some have just a few steps… one has 12 steps. There are two ground-floor Airbnb apartments in our palazzo complex that are owned by our neighbors. We rented one of them for my first two weeks home from the hospital. The apartment was perfect for those initial weeks, including a front door that opened directly onto a paved road for my first walks. Most of the streets in Lucca have cobblestones, so a paved street seemed like a luxury.

Given that my knee would hardly bend, it was not easy to get into our Mini Cooper. My doctor referred me to Marco, a physical therapist who comes to your house. He comes 3 days a week and I do need to cover the cost of these sessions. We have had several friends visit us and provide meals. A month or two ago we met a woman who recently moved to Lucca. It turns out that she was a nurse in America and worked at a hospital in Reston, Virginia that we visited more than we would have liked. Joanne visited us nearly daily, giving me my blood thinner injections, changing the bandages, and answering my stupid questions.

I have now moved back to my apartment. Marco walked me to my apartment from the rented Airbnb. He gave me instructions on how to tackle each set of stairs. My days are now filled with PT exercises, time using an automated knee bender, and walks around town. I’m also trying to pick up my daily chores. The weather yesterday was unseasonably warm so after our walk, we stopped for a Spritz at PuntoZero, a café across the street from our apartment. Allesio surprised us with a candle in our Aperitivo snack.

I have months to go before I am fully recovered but I feel very blessed by the good medical care that I have received and the many family members and friends that have supported me through texts, phone calls, visits and meals. And most of all the help provided by Jim all day and all night.

6 months in Italy and some glitches!

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But first a few pictures of the churches and streets illuminated for the Santa Croce festa on 13 September. Normally there is a long procession with people in medieval costumes, religious artifacts, and many local groups. Due to the coronavirus, much of the festival was cancelled or scaled back, but I loved wandering through the streets.

We arrived in Lucca on March 9th, so have now been here for more than six months. It feels the time has flown by, yet this now feels like home. While walking the familiar streets, I recognize many locals and even occasionally run into friends or acquaintances. But I still discover new streets, piazzas and stores. I’m now able to communicate as needed, although my pronunciation and grammar have lots of room for improvement. Phone calls are still tough. We are planning to buy a car within the next month or so and I now feel comfortable driving here.

But things aren’t exactly perfect here. We’ve run into a few glitches recently and both can give you a sense of the crazy bureaucracy here:

Permesso di siggornio: Getting our visa was challenging and took a long time, but it only gave us permission to enter the country. To stay, we need to get our permesso di siggornio (PDS). We applied in March, shortly after our arrival. We got the forms but of course all of the directions were in Italian. I googled and found some instructions on how to complete the non-intuitive forms, lists of documents to include, and tax stamps to attached. We turned them in and waited until the end of August for our appointment at the Questura (immigration office) to get our fingerprints. In the meantime, a local American friend introduced us to Tony, who helps expats and others through the crazy bureaucracy. A day before our appointment he checked on the status of our applications and that is when he discovered that I had made a mistake. A big mistake. I filled out one form because I had convinced myself that the form covered both of us. Nope…  I was supposed to complete one form for each of us. Bottom line, I had only applied for Jim. So, Tony helped me fill out MY form, we submitted all of the documentation again, bought new tax stamps and now I wait until December for my Questura appointment. My visa is valid until the end of February, so I should be OK. Ugh!

For Jim’s appointment at the Questura, we arrived before they opened per Tony’s instructions. There were about 20 people waiting for it to open, all wearing masks and maintaining social distancing. Then the door opened and everyone rushed to the front. Tony was there to maintain our spot and got Jim in for his appointment. That alone was worth the prices we paid for his services!

And no, the Questura appointment is not the end of the process. There are more appointments to finalize the PDS, get the identification card, and sign up for the national health insurance. And a slightly easier version of this is completed annually.

We also need to do several activities as part of an integration plan that we commit to. We are required to take training about the Italian government (a few hours of boring recorded training at a Government training location). Then take a test about the content a few years from now. Why wait two years, you ask? Because that’s how it work. We also need to take a test to show that we can speak and understand basic Italian. There are other activities as well, but those are the key ones.

The medical system: One of my goals for this year is to gain an understanding of the medical system. What better way to do that than needing some out-patient surgery! 

It turns out that Jim had a hernia…  We aren’t yet on the National Health Insurance so we have private insurance for at least the first year. We went to a local general physician who speaks English. He confirmed that Jim had a hernia, ordered some blood tests, and referred Jim to a surgeon. He is a doctor in the National Health system, so he doesn’t have a way to accept money from us. The doctors are paid a salary; they aren’t paid by the visit or the patient. Bottom line, the doctor appointment will cost us a nice bottle of wine. The doctors don’t have nurses or staffs. Before the coronavirus if you needed to see the doctor, you went to the office and waited for your turn. Now, you need an appointment. So you call or text the doctor to get an appointment – and they tell you when to come in. No nurse, no staff, just communicate directly with the doctor. To give the doctor the blood test results, Jim put them in an envelope and took them to the pharmacy by the doctor’s office. The doctor picks up results there and leaves info for patients there too. 

Getting Jim an appointment with the surgeon was a challenge for two reasons – I really struggle with speaking on the phone and it was August. Nearly everyone takes vacation in August: some for the entire month, most for a few weeks, but at least for a few days. I got the contact info of someone who could help me get the appointment and we communicated via WhatsApp. We had an appointment for several weeks later. Once we found the location for the appointment, we were pleased to find that the surgeon spoke decent English. He examined Jim and confirmed that he needed surgery, which would be done at the large hospital in Pisa. This would be out patient surgery, likely done via just a few small incisions. Next step is to meet with the anesthesiologist and do some pre-operative tests. 

When someone says Pisa, you likely immediately think of that leaning tower. I think of IKEA, Pisa University, and Cisanello Hospital (one of the best in Italy!).

We arrived at the hospital for the pre-operative testing and followed the directions to Building 10, the Orange area, followed the G route, then went down a floor to search for area 14. There was a long line outside of the pre-operative testing room and I tried to ask a question. They quickly realized that we couldn’t speak Italian well, whisked Jim inside and told me to stay out of the room. After about 3 hours, Jim came out to say that he needed a chest Xray and someone would lead us there. It was so confusing getting around that the “guide” asked 3 people for directions! Jim said most of the people spoke decent English. After about 4 hours total, we left. We walked around the city of Pisa and found a wonderful place for lunch. We got a glance at the tower; it’s still leaning. 

More directional signs than an international airport!

The next day, the surgeon called me. (No, not his assistant or nurse… the surgeon). He said that surgery would be Monday and we were to arrive by 10am. He gave us directions to the place to come for surgery and asked Jim to take a COVID-19 test on Sunday at 9:55am and asked that we pre-pay before the surgery. We had talked to our insurance agent and they will cover 80% of the cost, but we needed to pay up-front and they will reimburse us for 80% of the total.

We decided to pre-pay for the surgery on Friday so that we wouldn’t need to worry about it the day of the surgery. Boy, am I glad that we did that! After going to a few different buildings, we found someone who could help us. Because we aren’t using the National Insurance, no one seems to know how to deal with us. At one point, there were three people helping us and two people were called. After about an hour, they finally took our credit card.

Next step… the COVID test. We were told to go the hospital, parking lot A1, and look for an orange building with a tent next to it. Jim didn’t wait too long to have a swab in the throat and one in the nose. He also learned that we were essentially quarantined until he went to the hospital the next day. They said that they would call if it was positive, otherwise we were to come to the hospital the next morning.

Surgery day! Next problem… because we had paid on the Friday before, the date on some of the paperwork showed surgery on that Friday. Yikes! After lots of phone calls and a 1.5 hour wait, we were brought to Jim’s hospital room. The nurse showed us the room, including the bathroom and two beds. They said that I could sleep in the other bed. For outpatient surgery??? Surgery was scheduled for 1pm, but nothing seemed to be happening. Then they asked me if I wanted lunch and dinner. Of course, I was confused because I’m not the patient and Jim can’t eat. They ended up bringing me a decent lunch and dinner will come for Jim and I. They finally said that the surgery would be later than planned, probably around 2pm. Piano, piano… This “out-patient” surgery was going to include a night in the hospital.

After a few hours, Jim was returned to the room. The surgery was a success and his recovery has been very quick.

Bottom line, the medical care received was top notch. The administration and bureaucracy was very challenging!!!

Lots of words in this blog post, but I wanted to convey the complexity of life in Italy when dealing with organizations and government. Be sure to consider that very few of the people that we deal with regarding medical care, immigration, home repair, car purchasing, etc. speak much English. These conversations are typically a mix of Italian and English, with use of Google Translate when needed. But it is all worth it!