Scott & Sharon MacLean
Serving with CrossWorld in Northern Italy

 

Life in Italy

(click here for previous Life in Italy - August Vacation)

Our Experience with
Socialized Medicine


Let me start off with a disclaimer.  I know that some find this a sensitive issue and as such, I fear it can be a bit dangerous to touch.  This article is not meant to take a position on whether socialized medicine is good or bad, nor on whether or not the US should move in that direction. 

               But given that we have had ample contact with medical services over the past year, and given that we have had it both in and outside socialized medicine, I thought it might be interesting to some to hear of our experiences with both.  In sharing this, I will give some personal opinions, but please do not take that as more than that.  It reflects our personal experience with a certain level of health insurance and then in a certain countries socialized medicine system.

 Sharon's rehabilitation care took place in an excellent rehabilitation center in the USA.  We are very thankful for that.  She got top notch care in a facility with excellent equipment, well trained and very friendly staff.  It seemed as if all efforts were taken to make sure that every employee was smiling and friendly.  There was little in the way of paperwork to handle (most went directly to the insurance company) and they took care of arranging the few doctor's visits that took place outside their facility (both the appointment and the transportation.  So our experience was both excellent medically and very, very pleasant.

While we had a fairly substantial co-pay that we had to satisfy, for us it was well worth it to be able to have such excellent care.  Of course, if we did not have insurance, we would not have been able to come close to affording this care.  But given that we had insurance, we would much rather have the rehab in the USA in this setting.

If Sharon had needed outpatient rehab, that would have been subject to a very low annual limit on our insurance, so we would have needed to pay most of it out of pocket - something we could not have afforded to continue at that location.

Since we have been back in Italy, Sharon has been having outpatient rehab twice a week.  The rehab is good and the staff fairly friendly.  The care is competent and good, although not at the same level of excellence as we had in the USA.  The out of pocket cost, however has been minimal.  Since the therapy is covered by the system, we have had to pay only a miniscule co-pay (less that 2 a visit).  This low cost is a relief and we are glad for it.

There are some aspects of the care here, though, that are less ideal.  Setting up the therapy took several months.  And finding the right place for rehab was daunting!  Thankfully we have a friend who is a PT and could help direct us.  Without that I don't know how would have found something.  And the paperwork / legwork to get it set up was a bit more.  In general, setting up any kind of an appointment here means a visit to our primary doctor for a referral, a long wait at a registration desk (I have been able to set up a few on-line, but often that just does not work), and a long wait for an open appointment.

For example, Sharon had a clogged ear she just could not get unclogged.  We went to the primary care doctor, who gave us a referral.  At the reservation desk, the earliest appointment they could give us was over a month away.  Unless we were willing to pay a higher fee to get an appointment a few weeks sooner.  The waiting (both in line and for an appointment) is something that can get rather bothersome.

So, in general here we face lower costs (even that tax cost that funds the system is well less than what we would pay for insurance in the USA) but have a less smoothly operating system and much longer wait times.  The care that we get is good, although perhaps not cutting edge.  You may be more likely to find doctors that really don't care much and won't go the extra mile to check things out.  You often have to be your own advocate.  Also the "friendliness" or bedside manner of the care here is often much lower as is the overall quality of the facilities.

All told, for routine care - we could go either way.  While it is nice to have the lower costs, the hassle and long waiting times balance that out.

But there is one more consideration.  When we have had a need for emergency care here, we have found the system to work well.  Two examples:

A few weeks ago Karis badly sprained her ankle.  Unsure if it might be broken, I took her to the ER to get an x-ray.  They examined her, took an x-ray (nothing was broken), wrapped her foot and told her to keep the bandage on for a week and use crutches (which I had to go out to the store to buy).  Out of pocket cost for the ER - 0.  We did pay 30 to buy a set of crutches - which we will have for next time.

That is really nice!  If I were in the USA, with a big annual deductible, I would have agonized over whether or not to get an x-ray.  It would have been a significant cost and not something I would have been able to do - just to be sure.

A few years back I had a flu for two weeks that I could not get rid of (mostly because I was too busy to really rest).  In the end Sharon took me to the ER with a high fever and it turned out I had developed pneumonia.  I spent a week in the hospital.  The care I got was good, even if the hospital itself was rather old and rundown.  I had to walk down the hall, dragging along my IV stand, to use the bathroom.  When I showered, it was in a common bath for the floor.  But my out of pocket cost for the whole stay? 0  Again, that was really nice not to be facing a big deductible payment after a week in the hospital.

So for that kind of "low level" emergency care - I think our preference would be Italy.

So there are a few of our thoughts.  I am not convinced one system is inherently better than the other.  Each has its pro and cons and it is worthwhile, I think, to admit this in any discussions about the matter.