Diana holding the national Italian medical insurance card

Italy’s National Healthcare- How Does It Work?

Have you ever wondered what Italy’s national healthcare system is like?  By definition, the country provides universal coverage to its citizens and residents.  But what does that look like in the real world?

As an American in Italy living the expat life, this has been my personal experience:

Once a tax paying resident or citizen, you are given a medical insurance card.  When you receive your card, you must choose your family doctor, known as “medico di base” or base doctor, whom you go see for any medical issues.  This doctor can prescribe medications, exams, or other specialized visits by giving you a ticket request.

Now, a few initial issues with this set up:

  1. You can only choose a family doctor in your declared city of residence. If you do not currently live where you have your residency (let’s say you moved away for a couple of years to study and left your parents’ house as your home address because changing all of your documents is a pain in the butt), then you must travel back “home” anytime you need to visit the doctor.
  2. You also have little to none information about a particular physician prior to having to choose them as your family doctor. Internet researches will yield little to no results regarding credentials, degrees, expertise, etc., and unless you have a recommendation from someone you know, the only way to find out about a particular doctor is to choose them as your physician and give them a try for a month (the minimal amount  of time required before you can pick a different one.)
  3. There is no way to make an appointment in order to see your doctor. You simply show up and wait in line.  Sometimes you get lucky and there are not lines, sometimes you must wait for over an hour in a waiting room filled with sick people.
  4. Not all types of medical care are covered. As far as I can tell, dental and eye are not comprised in the coverage.  Gynecological visits are also typically done with private practices as you most likely do not want some random doctor assigned by the hospital all up on your who-ha (more on this random assignment of doctors below).

In order to illustrate what it would be like to get medical care through Italy’s national healthcare system, let’s play out a medical scenario:

Say you went to your family doctor because of chronic back pain you’ve had for months.  Your physician requests an x-ray by giving you a “ticket” request which you will then use when going to the hospital.  You call the hospitals in the area and find an opening two months from now.  You show up for your appointment, pay a sort of co-payment of 30 euro for the ticket, and have your x-rays done.  Now, let’s play out the worse-case scenario in order to illustrate how the system works.  As it turns out, you need back surgery.  The way you receive treatment through Italy’s national healthcare is you book the surgery with the hospital and they assign whichever surgeon is available (emergency procedures get booked ASAP, non-emergency ones, well, get in in line).

Yeikes, right? Not being able to pick your surgeon for a serious procedure… Talk about health care Russian-roulette.

There is, however, a way around this.

There are renown doctors who beyond having their own private practices, also work in the hospitals and are covered by the national healthcare.  Though you are not allowed to request a particular doctor when booking a hospital visit or procedure, you can however, pay to see them at their private practice first.  Once you’ve visited that doctor on your own dime (1,500 dimes for the top dog to be precise), they can then book your surgery at the hospital and have the procedure be covered by the national healthcare.  In this case, if you have the money, you don’t have to gamble.  Oh, the irony.

So, to sum up Italy’s national healthcare:

Yes, all tax payers are entitled to medical care.  However, the system has some major inconveniences and flaws, which results in most Italians paying for a private physician visit (anywhere from 80-150 euro) in order to see a specialized doctor they trust, and be able to book a visit within an acceptable time frame.  If you have the money, then you do not have to worry about the level of quality of care you will receive.  If you do not have the money and must only use the provided services covered by the national healthcare?  I, unfortunately (or fortunately depending the way you look at it), do not have enough experience to weigh in.  However, I have been meaning to remove a painful cyst from my right hand so I may be stepping up to the roulette table in the near future… could be fun, right?