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Trip Report: My Encounter With the Italian Hospital System

Trip Report: My Encounter With the Italian Hospital System

Old Mar 1st, 2015, 08:27 AM
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tom this is such an interesting and informative post.. thanks for sharing your experiences . I think one has to keep in mind that some of the niceties some of you are used to ie: care packages of toothbrushes, meals with menus, .. are luxuries you pay for and with the medical system in many countries those luxuries are foregone so that everyone can get medical treatment.. and I mean everyone!

In Canada almost all treatments are "Free", surgeries, hospital stays , xrays etc etc.. BUT.. we pay taxes and those of us who make over the poverty level ( which varies from province to province, in my province its under 15,000 a year for a single person) pay an insurance premium. The maximum amount is 66 dollars a month. That's it. If you make more then 15,000 but less then a certain amount.. you pay only a portion.. my son pays 10 dollars a month.

The downside to our system is you will wait for non emergency care.. a knee surgery etc can take months, .. but the upside is my mom had three heart surgeries.. all done immediately and was even flown to another large city for one specialized one.. and it cost us nothing.
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Old Mar 1st, 2015, 08:41 AM
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tom18,
Thanks for sharing this - it's fascinating reading your experience with the Italian health care system. The amenities may've been basic, but it sounds like your treatment was taken seriously.

Glad to hear that you were able to continue your trip after this episode and that you're alright now.
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Old Mar 1st, 2015, 08:42 AM
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tom18,

I do hope your story remains fascinating (rather than painful) and turns out extremely well, because I have to admit I am smiling from the familiarity of it all. The crucifix but no TV, the abysmal food, the curious roomates, the 1950s atmosphere. I was put in a ward with 20 other women, in two rows of beds, facing each other, but we had a beautiful view of the Emilian Romagna hills in springtime.

My treatment was excellent and it took away all fears of moving to Italy (where I now live). But I have to say that I once spent 7 days in a Japanese hospital, and they practically had to throw me out it was so peaceful, clean and the tip-toe nurses were so doting. They would bow and ask my permission every time they needed to give me an injection. (Free care. I never got a bill.)
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Old Mar 1st, 2015, 08:45 AM
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I meant to add that the hospital in Bologna supplied me with plastic cutlery, but I didn't realize I was supposed to wash it and keep it, and they were appalled at my wastefulness to discover I'd tossed it after my first meal. They gave me another set, with better instructions. They also stood over me to make sure I actually ate (the food really was awful -- the other patients accused the staff of being "fascisti" for making us eat.
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Old Mar 1st, 2015, 09:09 AM
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Very interesting report. In the end did you feel the Italian system / care overall was better or worse than in the US?

As an RN I can say that the move in recent years in hospitals in the US is to make them more and more hotel like - many have switched to all private rooms, individualized menu choices for meals, etc. Often the patients (and their families) treat the nurses like maids/waitresses rather than health care professionals, complaining if they don't get another hot cup of coffee right away because the nurse has a medical emergency in the next room. All the while everyone complaining about the rising cost of health care. Which is high not just because of all these things but primarily because of the crazy insurance system in this country plus the fact that medical professionals are afraid of being sued by a population being bombarded with TV adds by lawyers urging frivolous suits - so they order unnecessary tests and procedures.

There is a chapter in a great book describing the experience in an Italian hospital. It's "Head over Heels – Seduced by Southern Italy" by Chris Harrison. He's an Australian who moved to Puglia, the whole book is great but the chapter on the hospital experience sounds a lot like what is being described here.
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Old Mar 1st, 2015, 09:34 AM
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I am fascinated to read about the Italian system since I live in France. I was hospitalized just once, but I have also visited people in hospitals, so I am quite familiar with the system here. I have only seen double or single rooms except in geriatric wards, but my experience has been just in Paris and the metropolitan area. It is quite possible that small country hospitals are not like that. When I was hospitalized, we did get a menu on which to check boxes, but of course this did not at all make the meal outstanding. Portions seemed skimpy to me, but I did not have a condition that diminished my appetite, whereas most people seemed very sick and hardly seemed to eat anything. And of course it is wonderful to never see a bill for any of this.
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Old Mar 1st, 2015, 10:11 AM
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kerouac,

i was in a geriatric ward because my double pneumonia didn't require care beyond bed rest and an IV drip of antibiotics.

isabel,

one thing you might mind in the Italian system is, in the hospital where I stayed, the "Dottore" was treated like a god, with all the nurses trailing after him six paces behind.
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Old Mar 1st, 2015, 10:31 AM
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The interesting point about the food is that it sounds both OK and reasonably healthy: just (apparently) dreadfully cooked - though who knows what health and safety preoccupations haunt catering managers?

It sounds a significant advance on British hospitals. It's over 60 years since I spent a night in one - but on the odd day visit to elderly relatives, clinics, A&E (the English for what others call the emergency room) or MAUs (Medical Assessment Units:=Sezioni di Decisione Clinica), the catering fell spectacularly short of the clinical standards.

No water - but dozens of fizzy drink vending machines (which didn't stock water.) Snacks (free) mostly biscuits, cakes or prepackaged, petrol station standard, sandwiches. Ample hot food vending machines - but mostly highly processed food. Reasonably wide range of cafeterias - selling (cheaply) the kind of stodge I used to get at school. Occasional (free) hot meals served to beds - just like the stuff in the vending machines.

It's easier to get fresh salads at any pub or McDonalds now than at any UK hospital I've been to in the past 20 years

And all over the Great Anglo-Saxon Social Paradox. We're all familiar with the (English-speaking) fact that the posher someone is, the thinner they're going to be. In every British hospital, this means that doctors almost all look as if they're in training for a mountain climb (not least because most are). The non-medical staff look, mostly, like they're modelling for a "this is the kind of body that's going to get a heart attack" feature. So do the nurses.

My limited experience with Italian hospitals is that at least there are no vending machines - and the nurses and non-medics look as healthy as the docs.
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Old Mar 1st, 2015, 11:17 AM
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Hospitals are not uniform, of course, all over Italy. I've been in three hospitals in Italy, for very different reasons. I've never been in a private room, but the rooms I've been in never had more than three beds. There was always a bathroom in the hospital room, shared by the people in the room.

The food I've had has been bland, but neither scanty nor awful. Soups figured quite a lot on the menu, but I've also had pasta with a decent tomato sauce. The vegetables were overcooked and undersalted. The meat tended to be polpettone (similar to meat loaf) or a slice from a roast.

In two of the three hospitals, all the nurses were attentive and kind. The last time I was in the hospital, I wasn't allowed to get out of bed for three days, so I needed to ring my bell for help fairly often. Every time I presses the button, even at night, there was someone there in less than a minute.

There are a lot more male nurses here than I've seen in the US.

In Italy, at least in Le Marche, it's very common for family members to take turns staying at the hospital so their relative will have 24-hour personal attention. They usually bring a folding chaise longue so they can sleep during the night. The first time I was in the hospital, to have a rotator cuff repaired, a niece offered to stay with me all night, since my husband was going home. I told her I really didn't need so much attention! In fact, I've usually told my husband to visit me just for an hour or two. It really wasn't necessary to have him there all day, with all the attention I was getting from the nurses. However, he must have felt that it would be negligent not to stay there.
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Old Mar 1st, 2015, 11:55 AM
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Our health system is public, although there are private doctors, especially specialists, who usually work in the public system but also see private patients. Some specialists see only private patients. The specialists cost nowhere near as much as they do in the US. I think that because of the competition from the public system, they can't get away with outrageous fees.

We don't pay an insurance premium, but there are copays for laboratory tests and outpatient hospital visits if your income is over a certain level. These are reasonably priced also. Inpatients at hospitals pay nothing. There used to be a co-pay for medicines as well, but our ex-premier Berlusconi eliminated it just before an election.

When you join the public health system, you choose a family doctor from a list of all those practicing in your health district. Women also choose a gynegologist, and families choose a pediatrician for their children. These are all free, and you can just call for an appointment. In order to see any other specialist in the public system, your family doctor has to prescribe the visit. (This is also how it worked when I lived in the Netherlands.)

For non-urgent things, you have to wait months or longer for an appointment. For example, women are advised to call for an appointment for the next mammogram as soon as they've had one. (However, in my district, women most at risk, or in the riskiest age categories get an automatic appointment every two years, or every year if they're in a high-risk category.) If you don't want to wait, you can always go outside the public system. In my case, the cost of a private mammogram, the last time I had one (because I had delayed making the appointment), was €30. That was before they had the universal screening.

If I had to return to the US, I'd be on Medicare, not the new system, because I'm over 65. The people I know who are on Medicare still have pretty heavy expenses for drug plans, doughnut holes, Part B, Part C, etc., and not everything is covered. What the US really needs is a single payer health care system instead of a patchwork of Medicare, Medicaid, employer-paid plans, and private plans.

Here, I didn't hesitate, when I developed a rare blood condition that runs in my family, to seek out the best expert in Italy, who turned out to be one of the world's experts on this condition. I made the appointment myself, without a recommendation from my family doctor. We traveled to Milan to visit him, and I had all sorts of tests, including a bone marrow biopsy, and it all cost me just a few hundred euros. Then he wrote a letter to my family doctor, with his advice for follow-up.

One thing in the public system that's not top quality is dental care. Everyone I know goes to private dentists. The cost of dental care is lower than in the US, but not dramatically lower, as other private care is. I think this proves that the competition of a public system is what keeps costs low in the private sphere.
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Old Mar 1st, 2015, 11:55 AM
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I am mystified as to how flanneruk arrived at a description that the hospital food was "OK" -- given that all descriptions given previous to his or her post indicate that the patients with actual experience of it avoiding eating it as much as possible. Even when sick, the Bolognesi and Veronesi apparently want food that tastes good (and so do I.)

Family members were also acting as auxuillary staff in the Bologna hospital, but no non-patients were allowed to stay all night in the ward. Those in the ward who were ambulatory would often help out other patients. (In Japan, I was given a private room and my husband stayed with me, and I've stayed overnight in NYC hospitals with relatives).
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Old Mar 1st, 2015, 12:10 PM
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just joining in, to clarify for the non-europeans here, most european countries have a form of state run heavily subsidised or free health care.

in the UK it's all free apart from prescriptions for medicines though for the over 60s, children and those with chronic conditions, they are free too. IME the food in UK hospitals has improved too though quite a few people have food brought in by relatives and friends. There is usually a TV, and nighties/pyjamas are provided, though you can provide your own if you prefer.

Tom18 - like the others, I'm agog to find out what happened next!
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Old Mar 1st, 2015, 12:28 PM
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In 2013 DH leant out a window in our apartment in Venice to see what was happening in the street below. As he leant out he heard a pop and felt great pain. We thought he may have broken or bruised a rib.
He was in pain for the rest of the day and as it gradually got so bad he could hardly move we rang the " English speaking" doctor mentioned in our information pack from the rental agency who suggested we go straight to Pronto Socorso at Venice hospital.
Upon arrival DH was triaged and we were directed to the waiting room. No number or colour were given to us! There was no board showing waiting times. It sounds like we should have gone to Verona.
As we waited more and more elderly patients were brought in by ambulance. Also other tourists who appeared to have had falls. Obviously they were in worse condition and needed to be seen before DH. The room and adjoining corridors began to fill while only 1 or 2 people were called for treatment. The system seemed totally overwhelmed.
While waiting we both used the toilet which was dirty and had no soap or drying facility. There appeared to be blood on the floor.
We spoke to other people who had been waiting for longer than us. After about 3 hours we came to the conclusion we were going further and further back on the waiting list, with no hope of being seen in the foreseeable future. So I rang the travel insurance company who advertise that they help you. Their advice was to stay at the hospital and that there was nowhere else in Venice to get appropriate treatment.
We decided to leave as DH was in pain but not about to die so therefore not critical.
I would never advise anyone to go to Pronto Socorso at Venice hospital!
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Old Mar 1st, 2015, 12:36 PM
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We have reciprocal health care agreements in Australia with a number of countries and it seems Italy is one of them! So visitors from certain countries can access our Medicare system (I know of a traveller from UK who developed chest pain in Melbourne, had an angiogram and bypass surgery within a few weeks, something his cardiologist in UK said would never happen so speedily there).
Our many foreign students generally are required to take out insurance as part of their visa.
ileen, once we earn over a certain income (about $20,000) we pay a 2% tax as Medicare levy. On average, it is about $1200 per year. Public waiting lists (no fee)to see specialists can be long, (so private health insurance is an option) but public hospital emergency care is excellent.
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Old Mar 1st, 2015, 12:40 PM
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<i> In order to see any other specialist in the public system, your family doctor has to prescribe the visit.</i>

Same system in France, with a 10% co-pay, and, if I understood correctly, 20% if not with the family doctor's referral. For faster specialist service, we could see him on a Thursday when he consulted in his hospital office but it was his private day--we payed him directly (30€) and not through the hospital's billing service.
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Old Mar 1st, 2015, 12:43 PM
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Well, one should certainly go to the hospital in Venice if one is very ill or injured!

In Bologna, before going to the hospital, we asked the hotel if they could summon a doctor, which they did. I was running an extremely high fever, but since I complained of no specific pain and he couldn't assess any specific area of illness, he gave me anti-inflammatory medicine and left, having misdiagnosed me as not seriously ill. Within a few hours, I was beginning to feel lung pain, and went to the hospital, which was quite fortunate that I did.

On another occasion I went to a Pronto Soccorso at Genoa because of an alarming incident where I though I might have internal injuries. Staff quickly (and accurately) assesed my conditioning as non-life threatening, but asked me to stay for some tests. It was a weekend, and a long succession of people began arriving with motorcycle and sports-related injuries, and I finally told the doctors I would get the tests on my own and left.
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Old Mar 1st, 2015, 12:52 PM
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(By the way, before the private doctor in Bologna misdiagnosed me, a private doctor in the states had misdiagnosed me and gave me a green light to fly to Italy. Had the first American doctor behaved otherwise, I would have never had landed in the hospital in Italy.)
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Old Mar 1st, 2015, 01:12 PM
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I've several times had to take visiting relatives to the emergency room here in Italy. It's always been more or less like an emergency room visit in the US. Sometimes there was long wait, and sometimes not. My granddaughter had appendicitis this summer. We took her to the emergency room, where she was seen quickly, but we had to wait a long time for the tests to come back. My daughter was once bitten by a dog, and was seen immediately and had minor surgery to make sure that a tendon wasn't nicked. And my niece fainted twice, so we took her to the ER as well.

All of these people got excellent care. Twice they were not charged, because the amount was small, and it's a lot of red tape for the hospital. My niece had a lot of tests done, and was told she'd have to pay out of pocket and get reimbursed later by her insurance. The cost for all those tests was under €100, less than the deductible for the insurance.
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Old Mar 1st, 2015, 01:36 PM
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Just to add to the experiences.... I have been in italian hospitals three times.

First time it was an anaphylactic shock in liguria, i wasn't a resident at the time, we were in a small town. The doctor advised us to go to the next bigger town's hospital and not to wait for the ambulance. It is a miracle my husband didn't kill us at a traffic accident that day. At the hospital i was treated immediately and very well in the emergency room and didn't have to pay anything.

Second time was last july in rome when i had severe abdominal pain one sunday evening (which turned out to be a gastric episode). The ambulance we called came within minutes, at the hospital i was coded as yellow but there were no numbers or waiting times one could follow. In the end i waited for 5 hours, most of the time unconscious, on a gurney in an overfilled corridor, at times puking directly onto myself and the floor, with no attention whatsoever. I left after 8 hours with a (as it turned out) wrong diagnosis. The private doctor i visited a day later cost €130 and his diagnosis and prescriptions helpful.

The third time was this january in rome, when i cut my thumb very badly. The guardia medica, which is just steps away from my home and is open to everyone, bandaged me but said i can't get the necessary stiches etc there and sent me (by taxi) to the next hospital. At this hospital there was no color coding and no numbers. After waiting for 2 hours and seeing no one getting treated (turns out the doctors were on a sort of strike, where they were present but not working), i made some phone calls and found a private clinic that was ready to accept and treat me immediately. I got 5 stiches, which cost me €55 for material, and the visit (plus two following ones for controlling my thumb in the following week, each 5 minutes only) cost me €500.

So yes, we do have public health care system, but sometimes it is not good and/or enough, and then it can cost a lot.
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Old Mar 1st, 2015, 03:03 PM
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Thanks for an interesting report. I went to the Pronto Socorso in Foligno this past October. We arrived around 9 am and the waiting room was full with a line to "sign in". There was no board with information as to coding or wait time. After waiting several hours I went back up to the desk to eventually find out the XRay machine was broken & thus my long wait. At that point a doctor I think, put my arm in a sling offered some medications for the pain. I was told I could try and come back later in the day when they expected the XRay machine to be fixed or go to a neighboring town that was bigger. We left and returned later in the afternoon. I had an Xray, and a ~10 minute consult with an ortho doctor. The hospital itself looked like something from the 1950's. Most people seemed kind and tried to help me. It was difficult in that I speak minimal Italian and those few people who spoke some English did not speak very much English. I had the Innkeeper write on a piece of paper what was wrong with me which I imagine helped initially. About 6 weeks later I received a bill at my home for €68.
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