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A Lesson about Italian Health Care

Garabaldi holding his mask in Anghiari

One of the things we had to do when we got here was sign up for health insurance.  It’s required for anyone who (legally) lives here to prove that they have health insurance, either through private means or through the Italian government.  We looked into private coverage and found that, like in the US, it was expensive for not a lot of coverage.  So we went the government route.

I’ve written before about Italian bureaucracy and the insane amount of red tape involved in doing the simplest things.  But I’ll tell you one thing, once you get everything in place, it works like a charm.  About two months after I got my Italian health care card, I got a letter in the mail from my doctor (whom I’ve never seen).  I had been scheduled for a pap test!  I was wondering how to go about having these routine things done, but thought I would wait until I had better language skills and had fully recovered from trying to get the coverage in the first place.  I had no idea they scheduled these things for you.  All you have to do is show up.

No Boys Allowed

Steve and I found the clinic in Sansepolcro and showed up for my appointment.  We were pointed through a door and down a hallway with posters of pregnant women.  Looked like the right place for female stuff.  There was no reception area or a person in sight.  There was a waiting area, so we planted ourselves and thought we’d give it a few minutes before seeking out help.  An official looking woman came in and I told her why I was there and when my appointment was and she nodded.  She then looked at Steve and told him he had to leave and pointed back down the hallway with the posters of pregnant women.  This was a girls only zone and I rather liked that.

She disappeared behind one of the mysterious unmarked doors, but I was heartened that at least someone knew I was there.  A few minutes later, another woman walked in and asked me when my appointment was.  I told her and she nodded, saying hers was 15 minutes before mine.  I had gotten there plenty early since I didn’t know exactly where it was or what the protocol was.  She took her seat, then another women came in and asked us both when our appointments were.  I realized that there was no receptionist because the patients all sorted it out amongst themselves.

A few minutes later, one of the mysterious unmarked doors opened and a rather official looking woman (she was wearing a lab coat) came out and looked at us.  The women who had the first time slot got up and went in.  About 10 minutes later, she came out and left and the official looking woman closed the door again.  A few minutes she came out and looked at us and the woman who had the next appointment got up and went in.  I was glad my appointment was after these two so I could observe the system.  While she was in, another woman came in and asked me when my appointment was.  Knowing the drill now, I told her and she nodded and told me hers was after mine.  I was a pro at this.

About 10 minutes later the door opened and the other patient left.  The door closed for a few more minutes, then opened and I stood up knowing that it was my turn.  I went into a large room that was a combination office and exam room.  We started in the office part and she asked me a few standard questions (made much more complicated by my limited language skills) and I signed some papers.  Then we moved to the exam area.  There was no screen or private area for me to get undressed so I just did it right there in front of her and climbed up on the table.  I must say it was a little weird.  My experiences in the US provided for much more modesty than this.  You undress alone in the room then cover yourself up with a gown and crinkly paper awaiting the return of the doctor, who always politely knocks before entering.  She finished up, told me I would received the results within four weeks, and showed me out.  Then she proceeded to clean and sanitize the office/exam room combo for the next patient.

This was unlike any exam I’ve ever had.  There was no blood pressure check, no weighing, no medical history, no urine sample, no anything except the one thing that I had been scheduled for – the pap test.  It was a no frills, get ’em in and out kind of thing that did have a certain efficiency that I admired.  This was not a gynecological exam.  This was not checking for anything other than cervical cancer.  I’m pretty sure the woman who did it was not a doctor, despite her official looking lab coat.  But how many times in Atlanta have I had an exam performed by a PA?

I was in and out in 15 minutes after my appointment time.  I remember all the times I waited in my gynecologist’s office in Atlanta.  A waiting room full of people, men and women, looking at my watch as the minutes ticked past my appointment time.  Then I was called to wait in another room, then finally was put in an exam room where I waited yet again for the doctor.  The exam part only took a few minutes, but I waited 30 to get to that point.  I used to think that there should be an express line for people like me who didn’t have any issues.  Kind of like at the oil change place.  The express lube patients line up here, the pregnant patients line up there, etc.  I think Italy may have adopted that system.

A Different Kind of Test

A few days after my pap test, I got another letter from my doctor with a do-it-yourself kit enclosed for colon cancer screening.  It had detailed instructions on how to do this and instructions on what to do with it after you did it.  It was not the most pleasant thing to do, but it beat the heck out of a colonoscopy so I eagerly did it.  I know these tests are not as thorough as a colonoscopy, but an Italian friend of ours had his cancer detected this very way.

A few weeks later I got two letters from my doctor with negative results on both tests.  I’m not working anymore, but if I was, I could have done all this without missing even one minute of work.  The gynecologist appointment alone would have taken about two hours away from work, factoring in delightful Atlanta traffic.  For all the ways Italy is overly complicated, this was a very efficient and streamlined way of doing things.

An Invitation

One of the best things about all this was the way the letters from my doctor were worded.  It wasn’t presented as you have to do this, it was an invitation.  You are invited to an appointment for cervical cancer screening.  You are invited to perform a test for colon cancer.  It made it seem like I was special and it would be rude not to accept.

I also loved that they made the appointment for me.  I could change it if I needed to, but it was a place holder, something I was obliged to do.  And now these tests are part of my permanent record here in Italy and I will receive future invitations as necessary.  So I don’t have to worry about making an appointment or remembering when my last test was.

Basic Needs

This is not intended to make comparisons between the health care systems of the US and Italy.  They are very different and have different philosophies and approaches.  I’ve been blessed with good health in my life and don’t require any special treatments or needs.  So my experience with both systems is very basic.

I will say that Italy places an emphasis on basic needs of people.  One of the things that appealed to us was the low cost of food.  Italians believe that everyone should have access to good food and their food distribution system speaks to that.  Sure, there are expensive restaurants here that most Italians couldn’t possibly afford to eat in.  But almost every Italian can afford good, quality food, both to prepare at home or at a restaurant.  There are no food deserts here.  Italy is still very agrarian, so food is grown all over the country and most food is consumed within a few miles of where it grew.  I was always so frustrated at the rarity of being able to buy local products in Kroger.  To buy local, I had to go to a farmer’s market or subscribe to a cooperative service.  And that was expensive and time-consuming.  Blueberries are a prime example.  Georgia is one of the top blueberry producers in the US.  But at Kroger, the blueberries were from California or Florida usually.  Why?

Health care is another area that Italy believes everyone should have equal access to.  By letting us buy into their system, they’re saying to us that they want us to be healthy and well.  And by inviting us to attend to basic screenings that are proven to reduce the risk of cancer death, they are saying that they want us to be aware of things that we can easily detect.

I like that they place such an emphasis on basic needs.  You may have to take out a loan to put gas in your car, but you won’t go hungry.  You may not be able to buy Armani clothes, but you can afford a decent place to live.  You may not have a Ferrari, but you have incredible art masterpieces everywhere you turn.  You may not live in a palazzo, but you’ll be invited to a free cancer screening.

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