sandralist

I've had problems with hosptials in the US. I moved into my husband's hospital room at Beth Israel in NYC after I discovered they had mixed up his chart with another's patients chart and hooked the wrong one onto the foot of his bed. (It gave instructions for drug dosages, medication administrations, etc.) He recovered. I'm sure most of us could tell tales, bad adn good, and I am not naive in believing that Italy has the best care in the world (that would be France, yes?), or that regional Italian hospitals are all up to speed. Around where I live, people often travel to Milan for certain treatments, and there are some parts of Italy I would probably avoid growing old without a lot of reassurance about the availability of quality medical care.

However, looking at "outcomes", Italy is in the upper tier of quality. Here's Wikipedia with the big picture:

http://en.wikipedia.org/wiki/Healthcare_in_Italy

tom18

I love all the different perspectives that you all are providing. That's what's great about this board!

tom18

During my stay in the unit, I was given a few blood tests, another EKG and another echocardiogram (they told me they didn’t have access to the tests done in the ER because it was a separate department), a chest xray, and a carotid artery sonogram. Except for these occasional interruptions in my routine, I pretty much had nothing to do except work in the Sudoku book I had brought with me.

Visiting hours were strictly regulated and limited, from 11:30-1:00 and 6:30-9:00 p.m. From 2 to 4 p.m. all the lights in the ward were turned off for a rest period - which, I must say, seems pretty civilized when compared to all the hustle and bustle in American hospitals at all hours of the day and night!. During visiting hours, the sliding door to the hall was opened, but all visitors were required to exit the ward and the doors were closed if any medical testing or procedure was being conducted in the ward. Within the ward, however, privacy was nil, except for the lucky person in the one bed with the curtain. At night, the close quarters meant that everybody could hear any of the patients who were snoring in either of the two rooms.

The nurses wore all white (a white top and white pants). All of them that I saw were females, most of whom seemed to be in their mid-twenties to mid-forties. I don’t recall any of them who looked to be older than 55.

Most of the time the nurses and other medical personnel sat or congregated at the nurses’ station. They did not seem to have the frenetic work pace of nurses in U.S. hospitals, and there seemed to be a great deal of chatter among the nurses and other workers who would come into the nurses’ work area.

One of the nice things about the ward was that the nurses at their station could always see the patients and vice-versa. Whereas in U.S. hospitals, patients in their single rooms are remote from the nurses and must use a call-button or cell phone to contact the nurse, patients in my ward could just get a nurse’s attention in person. In addition, of course, the nurses could also monitor the patients and see what they were doing at all times.

Once a day, usually around mid-morning, an entourage consisting of physicians and other medical professions would show up for “rounds.” There was a definite pecking order, led by the senior doctor in his long white coat, accompanied by junior staffers in coats of various shorter lengths. Rather than the question-and-answer format of rounds popularized by American TV shows, the head doctor was clearly the all-knowing authority figure who lectured to his more junior colleagues. Everybody knew who was in charge.

On the wall of the Admissions Office in the community hospital where I live is a sign informing patients that if they do not understand English, they have a right to a translator to help them understand what is going on. No such sign graced the walls of my hospital in Verona. I spoke a little Italian, although my vocabulary was very basic and didn’t include many medical terms. And although a number of the medical professionals with whom I dwelt spoke some English, only a few of them were fluent enough to explain to me what was going on. At my discharge, I learned that one of the nurses on my unit had worked as a nurse in Pennsylvania and spoke very good English; but for some reason, she didn’t let on to that while I was there. So we got by with a combination of broken Italian, broken English, and pantomime. The only time I really understood well was when the young cardiologist “hunk” (my wife’s term) would explain it to me in his fluent English.

Finally, after two days, I was told that even though I needed my mitral valve “changed,” I was in no immediate danger and could continue my holiday. There were no forms to sign and the only paper I was given was a one-page report of my stay and the test results - in Italian, of course. When I asked about the bill, I was told I would be sent a statement “later.” Once they gave me the paper, I was free to walk out the door on my won.

It’s now been more than six months and I still haven’t seen a bill. Frankly, I don’t think I will, because I think both my ER visit and my stay in the observational ward will be picked up by the Italian taxpayers. If so, I will be thankful, but I’ll also feel a little guilty for paying nothing for my care.

Next: What is AOUI (and what happened to E?)

isabel

It sounds like the Italian medical system must be doing something right - although from your report it does sound like there were pros and cons. Italy ranks 7th in the world for life expectancy while the US ranks 36th. Italy (and most western European countries) spend around 10% of GNP on health care while the US spends almost 18%. Obviously there is more to it than spending - life style, genetics, etc. play a part, but still.....

Adelaidean

As to translators, we have had some challenges sourcing appropriate interpreters, for example 'Kuku', a Sudanese dialect, and today we needed a Bhutanese interpreter.

Our public system in Australia is financially unsustainable, but it is political suicide to introduce any form of charging or co payments, so inevitably taxes will need to rise and services diminish, to contain it.

bilboburgler

"Italy ranks 7th in the world for life expectancy while the US ranks 36th. Italy (and most western European countries) spend around 10% of GNP on health care while the US spends almost 18%. Obviously there is more to it than spending - life style, genetics, etc. play a part, but still....."

As someone who invests in the US health market, I can promise you it has some of the highest margins in the world. Why the US puts up with it is anyone's guess.

But all the free at the point of use "tragedy of the commons" type health services need a constraint management system (see recent Nobel prize for Economics), so maybe not paying for translation services ;-)

hetismij2

Glad you are OK.

I hope others don't assume health care is always free for visitors to Europe though and not bother with good healthcare insurance. Certainly in Spain they frequently want your insurance details, and here in the Netherlands too they expect payment!

bvlenci

Obviously, hospitals differ greatly one from another. Of the three hospitals I've stayed in, two looked like ex-convent dormitories from the 1950s, and maybe they were. One was very modern, but that was the one I liked the least. The staff weren't very attentive or caring.

This report is very interesting, and I'm following it attentively, but I wouldn't want anyone to think that the setup or rules were identical throughout Italy. I'm never seen this enforced nap time, nor nurses making sure you ate all your dinner, nor nursing stations that had a view of the patients' rooms.

bvlenci

I don't think most people would want to use medical services excessively just because they're free, although I'm sure there are some who go to the doctor because they're lonely.

Here in Italy, you don't make an appointment to see your family doctor; you just show up and wait. Our doctor is very popular, so the wait can be long at her office, on plastic chairs in the hallway of a hospital. That's enough of a disincentive for me, although it's one of the ways to keep up on the local gossip. She gives her patients her cell phone number, which is very kind of her. I've never called her, but I once sent her an SMS to ask a question.

sandralist

If you purchase travel insurance, it typically includes access to a translator-by-phone, who will speak with your doctors for you and translate what they say. I was also surprised by the near-complete lack of English speakers at the major hospital in Bologna. My translators ended up being a nurse whose family had worked in Canada when she was a child and an Italian-speaking American who was visiting her Italian grandmother in the hospital.

Regarding the grand parade headed by the senior doctor in authority, you could have heard a pin drop in the all-female ward I was in when I asked the doctor a question. I don't think a patient had addressed a doctor first in the 500 year history of the hospital. After getting over his shock, he was quite happy to talk to me about my condition. At a different hospital, I have been treated by female doctors who didn't seem to have the same elevated status.

I should clarify that nurses monitoring whether I was eating my food was directly related to my illness (I was told I MUST have the nutrients). Also, I was put in a geratric ward, where some of the women were very elderly and needed to be encouraged to eat enough. Otherwise, we never saw nurses unless they entered the ward to administer treatment. They hung out in another room down the hallway. Those in the ward who were ambulatory would go fetch a nurse if somebody needed one.

My experience of the system is that there ar constraints on doctors about how many tests they order, and whether they prescribe the cheaper medicine or the more expensive one. Like bvlenci's experience, my local doctor is "first come first serve" and his waiting room quickly fills up, and so most people think twice about heading to the doctor. Fortunately, pharmacists are allowed to dispense all kinds of remedies and take blood pressure etc., so that's usually the first stop, with hopes they won't tell you that you need to see the doctor.

flanneruk

"But all the free at the point of use "tragedy of the commons" type health services need a constraint management system"

For which the evidence is....?

In the system Bilbo & I know best, there's scarcely a scrap of evidence of net unnecessary demand, in the sense of people turning up at hospitals with a cut finger outnumbering those with advanced cancer still not going to a doctor.

There are cases of inappropriate demand - such as hospitals being used to store elderly people with nowhere suitable to be returned to - or, allegedly, foreigners presenting for free treatment they'd have to pay for at home. Though at my local A&E, it's mostly pissheads on a Sunday morning still waiting for treatment for fights they got into the night before. My GP is known to groan when some patients with heart risks just don't lose weight.

Overall, though, my experience as a child of the original universal, fully tax-funded, free at the point of purchase system (I was conceived more or less the moment the NHS got launched), is that tax funding actively discourages excess demand. At least among the "Call the Midwife" generation, a sense of not wasting scarce public resources strongly incentivises against frivolous use.

The anecdotes here of long queues etc are the result of the inevitable fact that, left to themselves, governments are better at not spending money than at anything else. Those queues in Venice come from no taxpayers voting for more free medical care for bloody tourists. They don't come from real Venetians clogging up A&E departments

tom18

I later found out that the Italian medical system contains two types of inpatient facilities, the public hospital (Ospedale) and the private hospital (Clinica di Cura). Public hospitals are run by the national health system and, as was true in my case, contain few frills. Care in public hospitals is free to all who are enrolled in the Italian Public Health system. Private hospitals, on the other hand, are more like most hospitals in the U.S., with things such as private rooms and bathrooms, television, and selection of food that can be ordered off a menu. Care in private hospitals is fee-based. In general, the quality of medical care in public hospitals (especially in northern Italy) is supposedly equal to that of the private hospitals; and indeed, the World Health Organization rates Italy’s medical system as second in the world, with only France’s being better.

The hospital to which I had been taken was Verona’s AOUI Hospital. I won’t even try to translate the initials, but as near as I can figure out, it is a public hospital basically equivalent to an American “teaching hospital” and is considered one of the best hospitals in Italy. If you go to the link below, you will see a photo of the hospital with the emergency room at the bottom http://www.mtitaly.org/images/docume...0aoui_engl.pdf).

When I got back to the hotel, the owner told me I was lucky, because the AOUI Hospital was “as good as the best hospitals in the States.” At first, I was a little skeptical, but my initial skepticism began to melt away the next day when I met an American from the Seattle area in the lobby of our hotel. It turned out that 18 months before, while this American was staying at this very hotel, he had had stomach pains and was admitted to AOUI Hospital. Tests revealed that he had stomach cancer. The doctors determined that he was too ill to be transported back to the U.S. and they therefore performed surgery on him, which was successful. Now he had returned to Verona to finish the vacation that had been interrupted. As he was leaving the hotel, he related to me that he had stayed in the hospital for 20 days, and for that and for the surgery, had been billed $17,000 some months later, which he had gratefully paid. The hotel owner later confirmed to me the truth of this story.

We continued our trip as planned with no further problems. When I got home, the mitral valve got repaired in our local hospital. Everything has gone fine.

Being hospitalized in Italy was definitely not the experience I would have wanted. But it did give me a unique perspective on Italian culture - and isn’t that why we travel?

asps

In Italy there are private and public hospitals. There are a few private hospitals (my mind goes to S. Raffaele and Humanitas, both in the suburbs of Milan) that are quite large, have emergency services, and offer both private treatment to paying patients and public health system treatment at the same price of public hospitals. But for these few cases, most private hospitals are relatively small and have a relatively low number of resident staff. Big doctors will come during the day and administer visits and surgery, but if an emergency happens during the night, it won't be unlikely that there is a single doctor on duty in all the (private) hospital, then an ambulance is called and the patient is dumped to the closer public hospital large enough to have 24/7 emergency service.

So while private clinics will have nicer rooms and better hotel treatment, I would not bet the level of medical treatment is better than public hospitals. I would not mind having a minor surgery in a private hospital if I can afford it, but for major surgery I would put my faith in a public hospital. If the worst comes to the worst, you will have an higher probability to survive.

asps

And just to put some figures - my father had to undergo major hearth surgery in Florence a couple of years ago; in the end, they gave him five coronaric bypasses. The surgery was programmed so he had the possibility of making a choice.

Surgery could be had under the national health system - a copayment would be required, but it would have been probably less than 1000 euros. But this way my father could not choose the surgeon performing the operation; it would have been a random surgeon on duty that day, probably they are all good.

The best surgeon at Careggi hospital was allowed to perform extra time surgery to paying patients. As my father had a private insurance, he chose this way; he could choose the surgeon and have a private room. The final bill, hospital, surgery, ten days rehab was something like 21000 euros, paid by his private insurance.

Then a nice thing happened. Due to an oversight in writing the tax code, my father could claim a tax credit (about 5000 euros) on his medical invoices, even if he was not the one paying them. So the following year he got a tax reimbursement for 5000 euros. He actually made money from his own surgery. He could not believe it, but it was absolutely legal and regular.

bilboburgler

"In the system Bilbo & I know best, there's scarcely a scrap of evidence of net unnecessary demand, in the sense of people turning up at hospitals with a cut finger outnumbering those with advanced cancer still not going to a doctor.

There are cases of inappropriate demand - such as hospitals being used to store elderly people with nowhere suitable to be returned to - or, allegedly, foreigners presenting for free treatment they'd have to pay for at home. Though at my local A&E, it's mostly pissheads on a Sunday morning still waiting for treatment for fights they got into the night before. My GP is known to groan when some patients with heart risks just don't lose weight."

Flanner, I suspect we agree after all which part of "pissheads on a Sunday morning still waiting for treatment for fights they got into the night before" is not unnecessary demand? Which part of people waddling into the Doctors to complain they are over weight is not unnecessary demand? How many smokers with related cancer are unnecessary demand?

If you have a commons-based medical service you need commons-based responsibility.

If you look at how agricultural water rationing occurs in parts of Spain you realise, since all the farmers want more water than there is, there has to be a control and Elinor Ostrom showed us the way.

Now all the UK needs is someone who has the courage to move the NHS forward without being accused of attacking it the moment anyone wants to do something other than just pay more for it. The demographics of tax funding just does not afford a free for all, it needs a control process. Maybe Simon Stevens has the bravery.

sandralist

tom18.

Single best and most helpful trip report I ever read online! Seriously. Along with the many comments. I'm surprised that people aren't clamoring for pictures. By the way, AOUI, for those interested is Azienda Ospedaliera Universitaria Integrata, which I would translate roughly as the Integrated University Hosptials Establishment.

Glad you found it so healthful and rewarding to have had this experience and tht all's well that ends well. I hope you enjoyed the rest of your stay in Italy and will be coming back soon.

asps,

Amazing story!

I have heard lots of pros and cons about the private hospital system. I do have some private doctors in Italy, and have used private clinics to get bloodwork done, etc. But I have never heard a consistent case that private hospitals provide better care in any key area. Generally speaking, whether it is the US or Italy, educated people who get a serious diagnosis do a little "hospital shopping" to see where the best care is, and get the best they can afford. Italy has an extremely long track record in successful, holistic medical care, and a commitment to universal access, so it deserves its high-end rankings.

flanneruk

"Which part of people waddling into the Doctors to complain they are over weight is not unnecessary demand? How many smokers with related cancer are unnecessary demand?"

Americans are less likely than Britons to be overweight? They're less likely to smoke?(http://gamapserver.who.int/gho/inter...use/atlas.html)

Your examples demonstrate my point. What farmers do with water (or Saudi Arabians do with petrol) tells us nothing about how, in a culture of social responsibility (which may have disappeared in Britain's perpetually whingeing periphery, but is certainly alive and well in the Cotswolds), real people treat scarce medical resources.

It doesn't even tell us anything about how people treat commons. Walk ten minutes from where William Forster Lloyd gave the lectures in 1833 alleging that commoners misuse commons (from which the "tragedy of the commons" myths derive). There on Port Meadow you see a common, surrounded by its commoners. The only thing being abused is the skyline - thanks to Lloyd's modern successors. Not a hint of overgrazing.

As with his contemporary Malthus, there are occasional examples of Lloyd's theories turning into reality. But there are lots of examples where they don't - because human motivations are far more complex than 19th century ivory-tower mathematicians ever factored for.

ileen

Very interesting reading as it is educational and helps all travelers.

Now, I am wondering how many of Fodorites, who don't have any health concerns and are healthy venture on a trip without getting medical insurance.

We have traveled quite a bit, and are in decent health. So wondering if I have to think about purchasing travel insurance in the future and how much does it cost and where do you buy it.

Just want to learn more as we are definitely getting older and may need some help down the road.

Thanks for your input.

maitaitom

"We have traveled quite a bit, and are in decent health. So wondering if I have to think about purchasing travel insurance in the future and how much does it cost and where do you buy it."

Because of my health (or non-health) issues, Tracy purchased trip insurance for us on our last trip to Paris. It turned out to be a good thing, because I indeed got sick over there. I haven't gotten to that part of the trip report yet, so I don't have the exact calculations at my fingertips, but I do know that the policy more than paid for itself.

You never know when it can come in handy…and yes, we have purchased travel insurance for our future trip to Spain.

tom18…thanks for the incredibly informative report. I hope I never have to use any of your information, but when we return to Italy, your report will be electronically stored somewhere for us.

Elizabeth_S

tom18 - glad it all worked out for you.

My experience with the Italian health care system was in 2005. We were staying in Rome for 2 months and the first week I stumbled on pavement and injured my wrist. After 24 hours of ice/etc I knew it needed to be looked at. We were going to go to the American Hospital but a lovely neighbour of ours said we would be fine going to the Ospedale Fatebenefratelli on Tiber Island (we were staying in Trastevere so it was a 10 minute walk).

It was a terrific experience. Upon arrival they realized there was a language barrier - I think they fast tracked me to an emerg doctor who spoke perfect English (and I'm sure it wasn't very busy). Dr. Beatrice - can't forget that name.

He ordered x-rays and felt the results were a bit ambiguous between a break or a sprain and immobilized it with a fiberglass half-cast (half open/half closed) which he advised I should wear for a couple of weeks. He assumed we'd be on our way before the two weeks were over and advised I have it x-rayed upon my return home. Well.....we weren't going home and would be in Rome for another 7 weeks.

So we left that day with a follow up appointment for 2 weeks hence - we were told that visit was free but we would pay for subsequent visits (i.e. to have the cast removed/another x-ray etc). I determined in advance that the costs would be much lower than our travel insurance deductible so never bothered making a claim.

So two weeks later we presented ourselves and another x-ray revealed all was well - it was a long-ish wait in a hallway without alot of instruction but we managed. (By that point Richard had discovered the hospital had a bar - enough said).

But....the radiologist (Dr. Fabio - and he was in every way) was concerned I needed some physio - so back we went to the hospital a couple of more times.

All told the fees (which we paid in advance at a cashier's office prior to treatment) were about 80E after the first free visit.

I received terrific care - and my wrist is fine. It's funny - that was our first winter leaving Toronto for an extended period and we said we wanted to experience "living" somewhere else.....we laughed that we had certainly done that in Rome.