Tag Archives: Lucca

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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.

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A rather plain church but… oh, the history!

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I’ve heard that you can see parts of Lucca’s Roman Wall inside of the Chiesa della Rosa (Church of the Rose) but it is seldom open to visitors. So I was excited to be able to go into this church for an evening service. The façade is so simple and the building is so low that it does not even look like a church. But this little church is just bursting with history!

First the legend that explains the name… During Roman times, shepherds would bring their sheep to this area outside of Lucca’s wall to rest and get water. One young shepherd who could not speak was surprised to find a bright green bush in the middle of winter. He went to investigate and found a beautiful blooming rose. He picked the rose and brought it to his father – and miraculously he could speak! News of the miracle spread and a wealthy family built a small private chapel here so that they and others could always remember the miracle that occurred here.

In 1309 (yep… a long time ago!) a request was made to the city to expand the chapel to make a small church. The document said that there was a beautiful fresco of the Madonna and Child in the private chapel and that it would be moved to the altar after the church was built. The fresco was called “Madonna, holding a Rose, and with St Peter and St Paul“. When it was moved (very difficult for frescos!), St Peter, St Paul, and parts of a few angels were lost, but the fresco is now on the altar of the Chiesa della Rosa. This fresco is now believed to the oldest piece of art in Lucca.

One of the walls of the church is the original Roman Wall of the city from the first century BC. This was a common practice at the time that saved the cost and work of building one wall. You can easily see the original stones, huge blocks of limestone, on the left hand side of the church’s interior. Several small portions of the walls have been discovered throughout Lucca, but this is the only substantial portion that is available to be seen today.

As is common, the church has undergone multiple renovations over the centuries. The interior is a delightful mix of styles with very intricate windows on the right hand side.

In May 2019 we rented a small apartment for a month that was on the same street. I stopped several times to look at these windows from the street and couldn’t make sense of them. The building just doesn’t look like a church from the outside – too small, no grand façade, etc. This evening with the lights on inside of the building, the light shines through the beautiful blue glass and it clearly looks like a beautiful but small church.

When you look closer at the exterior carvings, you see many beautiful carved roses at this Church of the Rose.

Every time we go down this street, I will remember the stories, art, and Roman walls that are hidden in plain site.

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Our first visitors from America!

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At the end of September 2021, Derek, our son, and Dani, his girlfriend, came to visit. It’s been 18 months since we’ve seen Derek or any family member, so you can imagine that we were quite thrilled to see them. We had a wonderful time with them and visited some new sites and some familiar ones.

Pickup in Rome. Derek and Dani flew into Rome and were set to arrive early in the morning. So Jim and I drove down the day before and stopped at Tarquinia, an hour north of Rome on the coast. The city is known for their Etruscan tombs and Etruscan Museum. I’ve seen a lot of Etruscan stuff, but I was surprised at the beauty and quantity of these tombs! In this necropolis there are 22 different underground tombs that you can look into with beautiful painted walls. Each tomb has a modern building covering the tomb with steps going down. Lighting was not good (to protect the paintings), so I’ve included one from the town’s museum, which was moved for accessibility and protection. I’ve also included a picture of a decoration from one of their temples. Keep in mind that these are from the 4-6th centuries BC!

The next morning Derek and Dani arrived on time. After more than a few hugs we were off to Sorrento where we planned to spend 5 nights.

Sorrento, Amalfi Coast, and Capri. None of us had ever been to this region so we were excited to explore the cities, the views, and the sites. While approaching Sorrento Jim stopped for a view of the city… the view was a great first impression, the traffic not so much!

We headed to Capri Island the next day… joining a boat trip from Sorrento, went around Capri, a short swim break and then a stop at one of the marinas. We visited the town of Capri, filled with shops selling beautiful (and overpriced!) souvenirs. Jim and I enjoyed wandering through the small streets while Derek and Dani headed to another marina to check out some of the boats. The wait to see the famous Blue Grotto was over an hour, so everyone on our boat agreed to skip it. Instead the captain stopped at two of the lesser known, but equally beautiful grottos, and Derek, Dani and many of the others jumped into the water to check them out.

The next day we headed to Pompeii where we spent hours wandering through the city. “Pompeii is a vast archaeological site in southern Italy’s Campania region, near the coast of the Bay of Naples. Once a thriving and sophisticated Roman city, Pompeii was buried under meters of ash and pumice after the catastrophic eruption of Mount Vesuvius in 79 A.D. The preserved site features excavated ruins of streets and houses that visitors can freely explore.” (from Google) I was struck by the size of the city and how well preserved everything is. There were so many details here and there that really gave you a sense for life in an early Roman city. I definitely want to spend more time here.

And the next day we had another boat trip planned – leaving from Sorrento and going along the Amalfi Coast. My knee was too sore at this point, so Jim and I opted to stay in Sorrento while Derek and Dani headed back to the boat. They had a great time, seeing several small towns and popping into the water at a few swimming spots. Each evening of our trip, we had dinner at one of the restaurants that featured local delicacies and a good wine list.

Local food… delicious wine…

Chianti. We had planned for one more day in the Sorrento area, but we were all ready to move along. So we headed towards home, stopping for a night in Castellini in Chianti. This small town holds special meaning for Jim and me. In 2016 we stayed here and used it as a base to explore this part of Tuscany. One evening after dinner as we wandered through the town, we paused to look at the available real estate in one of the realtor’s window. That was the evening that we realized that living in Italy would be affordable for us and planted the seed to “retire in Italy someday”. At the time, we expected that to be a decade or so away, but why wait???

We were in Chianti, so naturally we visited a winery and some of the nearby towns.

Next stop, Lucca! Derek and Dani were likely tired of hearing us talk about what a wonderful city Lucca is to live in and they now had an opportunity to check it out. They stayed in Lucca for a week… we spent quite a bit of time in town, but also used it as a base for day trips. I’ve included some photos of our time with them, but they also visited a nearby cave in the mountains, took a cooking class, and visited the Irish Pub (in Lucca???) multiple times. You’ll need to ask them if Lucca lived up to the hype from Jim and me…

Derek and Dani then left Lucca and wandered around Europe for another two weeks, visiting Prague, a small German town, a few places in Switzerland, Chamonix, and Milan.

It was wonderful to spend time with Derek, to really get to know Dani, and to show them some of the aspects of Italy that we enjoy so much. We are looking forward to future visits from our family and friends!

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Mini-vacation to Florence

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With the Covid pandemic coming under control, the Government has relaxed some of the restrictions. We wanted to visit Florence for several reasons, so we decided to head there for Saturday and Sunday (May 8 & 9, 2021).

After our first trip to Italy, Mike M. asked me if I had been to Piazzale Michelangelo. It sounded so wonderful, but no… we hadn’t visited it. I vowed that I would visit it in the future and we have now done so many times now. On Saturday, it was our first stop of our mini-vacation. From this grand piazza, you can see all of the gorgeous city of Florence. And we even listened some live blues music while enjoying the view.

I had read that the Irises were in bloom and so we searched for this special garden and found it (along with a lot of other people). The Irises were spectacular!

We enjoyed a nice lunch at the restaurant right next to Chiesa Santa Croce (with brown umbrellas in photo below). This is one of our favorite piazzas in Florence, so it was nice to return. We’ve been trying hummus whenever we see it on the menu and especially appreciated all of the fresh vegies as dippers. Although hummus isn’t considered a traditional Italian dish, chickpeas are used in many different dishes here. My favorite is cecina.

We walked around some of the main sights of Florence and were pleased to see that there were more people now on the streets and around these sights. Here’s a few pics of the unique and beautiful Florence duomo. Gotta love that dome – no one still knows for sure how it was built and why it is still standing!

I wanted to spend some looking at and reading about the sculptures in the Loggia dei Lanzi so was a bit disappointed that people are still being kept from this open air exhibit. I suppose too many people could gather in the area… It was built between 1376 and 1382 and the various sculptures have been exhibited in the space since then. I like the two lions on the steps: the one on the right dates from Roman times, the other on the left was sculpted by Flaminio Vacca in 1598 and was originally placed in the Villa Medici in Rome before being moved to the Loggia in 1789. The history here is mind boggling!

For dinner we ate at Cantinetta Antinori, our favorite restaurant in Florence. Antinori is one of the biggest wine producers in Italy and the restaurant is located in the family’s Palazzo. Because the COVID rules allow only outdoor dining, everyone was sitting in the Palazzo’s courtyard. It was a delightful setting, great food, and tastes of many of their less well-known wines.

Apparently I was tired of taking pictures, because I have none for Sunday! But it was a lovely day… We went to Mosaico, an English-speaking church that we’ve visited before. Then visited a friend that has recently opened a store/bistro that sells Italian and French (yep, French!) cheese and wine. We enjoyed visiting with Rebecca, savoring many new and interesting cheeses and buy several items from the shop. When you next visit Florence, be sure to stop in at Formaggioteca Terroir.

Coronavirus Update

Tourists are now allowed back into Italy! Yay! We are still waiting for some of the specific rules, but generally tourists will need to prove that they don’t have COVID before entering. We are still wearing masks in public (inside and outside) and haven’t heard much discussion of the relaxation of these rules. Restaurants are opened for outdoor dining but starting June 1st, we can eat inside, at least for lunch. This is important because we’ve been having lots of rain, so the restaurants have hustled to get tables available outdoors with umbrellas.

Italy got a slow start in distributing the vaccines, but the pace is definitely increasing. I have received two doses of Pfizer and Jim is scheduled for the Johnson and Johnson vaccine on June 7th.

Despite the improvements, we have a conservative travel plan for 2021. We plan on exploring various parts of Italy in 2021 and then to visit other European countries in 2022.

If you are planning to visit Italy, please let us know. Lucca is a great city to visit and to use as a base for many days of exploring Tuscany (Florence, Siena, wineries, hilltop towns, beaches, etc.) as well as Cinque Terre. If you can’t make it to Lucca but will be spending some time in Florence, we can come for a drink or a meal. Italy is looking forward to the return of the tourists! We are looking forward to visitors too!

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Two quiet months but more freedom now!

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It’s been about two months since my last blog post. I’ve thought about writing, but not much has happened for the last two months. The coronavirus restrictions have varied between very strict and strict, so our activities have been greatly limited. But there are a few updates to share.

One year anniversary of living in Italy: We arrived in Lucca on March 9th one year ago, excited to start this new chapter of our lives. COVID and coronavirus were new words/ideas for us, but so was so much around us. The excitement of retiring and moving to Italy sustained us for most of the year and we treasured our opportunity to spend so much time in Lucca and wander around Tuscany occasionally. As we passed a year, I found myself grumbling… second Easter in lockdown, second time we’ve celebrated Jim’s birthday in lockdown, second time for this and second time for that. But I know that we have been so greatly blessed to pass the pandemic here and (being retired) were not greatly impacted financially. I still need to remind myself of this every few days…

Medical care: we now have full access to the Italian medical system. For our first year in Italy, we delayed most medical activities and only dealt with issues that needed to be handled – because of the pandemic and our medical insurance only covered larger issues.  We now have a general physician, are catching on preventive medical activities, and addressing issues that we have ignored.

Eye surgery for Jim: The biggest medical issues was that Jim needed outpatient surgery on his left eye – Epiretinal Membrane (ERM) Surgery. This is not a typical / routine surgery so we had the condition and recommendation confirmed by two doctors in Italy and more confirmation from Jim’s doctor and ophthalmologist in Virginia. After waiting for a few months, he was scheduled for outpatient surgery last week. Everything went smoothly during the hour-long surgery and all indications are that the problem will be fully resolved. The recovery has been a bit more involved than we expected with three different eye drops four times daily AND he needs to keep his head down as much as possible. We have been very impressed with the medical care, with multiple follow-up visits. No cost for the surgery and the eye drops cost about €12 each.

Language study: Jim and I are continuing to study with online tutors. As part of our Integration Agreement with the Italian Government, we need to achieve a competency level of A2 within two years of arriving. Because I started studying the language a few years before we moved here, I was ready and took my A2 test on April 15th and should hear the results soon. However, that doesn’t mean that I’m fluent or anywhere close. That became clear to me after a very confusing episode at a medical clinic when I went for my appointment at 14:00 on April 8th rather than 8am on April 14th. Oh well… 

Driver’s license: I am now turning my attention to studying for the driver’s license test. The test is a challenge even for Italians and is in Italian only. The test has 40 true/false questions drawn from a known set of 7000 possible questions. You can get a maximum of four wrong in order to pass. I can drive with my US driver’s license and an international driver’s permit until January 2022. There is a lot of new vocabulary to learn, including 100 new verbs: to tail, move away, support, take advantage of, compress; squeeze, flow out, avoid, brake, throw/jettison, crack/deteriorate, …

Time with friends: We have been fortunate that we’ve been able to continue meeting with friends, including having two people (and their children) to our house at a time. We’ve continuing meeting with Brian and Victoria for Bible studies and enjoyed Easter with them and their two daughters. We’ve had Pasquale (an Italian friend) for dinner weekly, had a few cooking lessons from Evelin (Pasquale’s chef), enjoyed a brunch at Sharri and Jedd’s house, and visited with Nicola and Rebecca when Vinarkia was opened for takeout. And I have certainly appreciated staying in contact with family and friends through social media and phone calls.

Here are two pictures that I’ve took one evening from our apartment:

A quiet evening in Lucca
Moon rising over San Francesca

San Frediano, a nearby church replaced a bell in its tower and installed a new system that allows their bells to be played by electric motors or moved by string. The changes were announced in the local newspaper and we enjoyed a mini concert from our apartment on Sunday. I’ve included a bit of the audio and a picture.

Church bells from San Frediano
San Frediano, ready to share her new bell with the community

Starting today the coronavirus restrictions have been eased. We now have a Yellow status, meaning that we can travel within Tuscany and other Yellow regions, restaurants are opened for outdoor dining and there are plans in place to start opening museums and cinemas. And talk of opening up Italy for tourist in the months to come! Will we see you in Italy this year?

I am so ready for this!