More about the the national health system SSN (Sistema Sanitario Nazionale)
Tuesday, November 3rd, 2020
I now have significantly more experience with the SSN. Since I am not an Italian citizen I enroll each year by paying a sum based upon my last year’s income. Since my basic income is Social Security that has averaged about 1650 euros a year or just under 140 euros a month which at today’s rate of exchange is about $160 which is incredibly cheap by U.S. standards. Visits to the primary care physician are free for everyone. Visits to specialist or for things like X-rays usually require a copay but since I am over 70 I pay nothing. The cost of prescription drugs in general are much lower and again in my age range they are often free. All of these things are very positive.
Now let’s look at the negative side. First, it is definitely not very convenient to see even your primary care physician. Often they have more than one office and the one nearby has limited hours. Some accept reservations and many do not. My first doctor, Dr. Barbiere, has 3 periods a week in his office nearby, each for about 2 hours, no reservations. I found him reasonable to work with but I always arrived at the door of his office at least 15 minutes early and even then there were often a couple of people ahead of me. But still the wait was not very long. If, however, I arrived at the beginning of office hours there were often 5 or 6 people already in line and the wait could be 30-45 minutes. My current doctor is worse in many ways. He requires reservations for much of his office hours but then makes it incredibly difficult to make one. He’s not as pleasant as Barbiere but seems quite competent and has reasonable patience with my limited Italian.
Specialist visits are definitely a problem. Often the first appointment available in the province (like a county in most states in the U.S.) could be a month or more away and even then physically distant. I already wrote a blog post about seeing ophthalmologist in Bentivoglio which was a similar distance with sparse bus service. To see an SSN orthopedist I had to go to a little city Loiano, 30 km away through secondary roads and required about an hour by car (thankfully Laura has a car here). I found that orthopedist quite unpleasant and wound up going to a private one here in Bologna. For the private guy who was recommended by a friend I had to pay 118 euros but I could make an appointment a week in advance. Recently I had an MRI and for that I had to go to Castiglione dei Pepoli which is about 60 km distant but with better roads so the trip was less than an hour. Another alternative is, of course, to go to the emergency room (Pronto Soccorso) if the problem is urgent. I had an ear infection that became increasingly painful and following this route I could see a specialist fairly promptly. In any emergency room if you are not badly injured there is always a wait probably in every country but I received excellent care and resolved the problem completely in about a week with various measures taken.
Prescriptions for medications tend to be much less convenient here than in the U.S. I had a Medicare Advantage plan with Kaiser and could refill prescriptions online easily and have them arrive in the mail after 3 days. Now if I have a way to contact my doctor without going there physically I can get a prescription on-line but still must go to the pharmacy to get it filled.
In summary the system works but with many inefficiencies. If only there were a system to make an appointment online with your primary care physician that would help things a lot and is clearly doable through appropriate software even if the doctor has no staff – which is usually the case. Similarly easy communication via email and/or text messaging would alleviate much of the problem. The long waits for non-urgent diagnostic tests or visits to specialists is endemic to the system. The only way to resolve that would be more doctors and specialists and inevitably higher costs for the system. To me that would seem a reasonable tradeoff. But on the other hand the health coverage is universal without regard to wealth – although if you are willing to pay you can always see a competent specialist much more quickly.
One other thing is the over-the-counter medicines like aspirin, as an example, cost significantly more than in the U.S. but balancing that against the lower cost of prescription drugs seems much better to me.
Other asides for today’s post. I am writing this while it is still early morning on election day in the U.S. with all of the turmoil there like nothing I have ever seen before. If I were religious I’d be praying for a positive outcome and no violent reaction. The pandemic is still raging without pause in the U.S. and the second wave here in Italy has been a veritable tsunami. Laura and I are going out only for necessities and with an N95 mask. It’s something of a perfect storm.
At least I can end on a positive note with another Baci citation.
L’amore è un bellissimo fiore, ma bisogna avere il coraggio d coglierlo sull’orlo di un precipizio.
Love is a beautiful flower but you must be brave enough to pick it from the edge of a precipice.
Stendhal
P.S. If I have any Italian readers I’d like their opinions on the SSN and correction of any misunderstandings that I have about the system.
And a final note “this too shall pass”.
