The Local news@thelocal.it
@thelocalitaly
18 December 2019
Having a medical emergency in Italy before
you've got to grips with the healthcare system is many foreigners' nightmare.
Mark Hinshaw, an American resident in Le Marche, explains what happened when he
found himself in an Italian emergency room – without health insurance.
The boy asked me: “Why is your face red? Did
you run here?”
I had just arrived at his parent’s house to
join them and some mutual friends for tea. Their house is a ten-minute walk
from ours along a flat street and then up a short, steep winding lane. I walked
very slowly, stopping several times, as I felt winded.
I had been short of breath for weeks. I had
trouble breathing at night. As soon as I lay down, my breath immediately became
laboured. I had a disconcerting wheeze. I felt tired and listless. All bad
signs; all I had ignored. I blamed it on the unseasonably hot weather in July.
We had lived here for two years. We had
private health insurance for our first year, as required by
our elective residency visa, but not in the second. And for a
variety of reasons, we were not yet signed up for the national health
programme.
We knew we were taking some risk, but neither
my wife nor I had ever needed to see a doctor. For basic aches and pains, we
relied upon our local farmacia, with its affable and helpful owner.
Although we knew the comune offered a free, open clinic
several days each week, we never went. We simply were never sick.
Ignorance plus ignoring obvious symptoms is
not a good combination.
Given the boy’s pointed question, I decided to
go to the free clinic the next morning. After all, it was merely a hundred
metres from our front door. I waited with a half dozen other people, most of
whom we knew as other residents.
The dottoressa took my blood
pressure and heart rate. Both were significantly elevated. She said I needed to
go to the hospital, which was 30 minutes away. Could we get there on our own,
or would she need to call an ambulance? This was sounding pretty serious.
She explained that emergency services were
free and this was clearly an emergency; I needed care immediately. She wrote a
note on her stationary, explaining that.
My wife drove us quickly but cautiously. By
the time we arrived, I barely had the energy to walk to the Urgent Care door.
The doctor’s note got us past reception within
minutes. I sat down for an EKG, which showed an erratic heartbeat. I was placed
on a gurney to wait my turn for treatment. Every so often a nurse would come by
to check on my status.
It was dawning on me that this whole thing was
a lot more life-threatening than I thought.
Indeed, after a series of exams, including a
sonogram, I was given a diagnosis. For months, it seemed, my lungs had been
gradually filling with fluid, eventually to the point of my not being able to
breathe easily. The increase had been gradual enough for me to accommodate to
it, but it had finally reached a critical point. And because my heart had to do
much more work in pumping, it was now enlarged. I could easily have had heart
failure at any moment.
Within a matter of hours, a small team of
doctors and nurses had drained much of the fluid and put me on a regimen of
medications, lots of sleep, and no physical exertion.
I was impressed with the state-of-the-art
equipment at their disposal, despite it not being a huge urban hospital.
Moreover, every member of staff was attentive, caring, and reassuring.
All my previous fears and misconceptions of
receiving medical treatment in a different country disappeared. Though there
were some surprises: Americans are used to a lot more privacy in medical attention
than here. Other people were treated in the same room I was in, although with a
fabric screen in between.
At one point the nurse asked me for a urine
sample. Immediately I looked around for a restroom. Seeing none, I asked:
"Bagno?" She said: "Qui!" Alrighty then.
My wife speaks Italian pretty well, so she
worked as my translator. The intake person spoke some English, so there wasn't
any difficulty there. The medical staff spoke mostly Italian and my wife's
skills were important then, as there was some technical stuff. I was by myself
for some of the time, however, and I managed OK with my beginner-level
Italian.
As my awareness of my surroundings became
sharper, I realized another thing that was quite different from my experience
in the US. The physical plan – the halls, lobbies, entrance, rooms, waiting
areas – were all very plain. In US hospitals, there is often an attempt to make
it seem like you are staying in a resort: elegant furnishings and flooring.
Dramatic lighting. High ceilings with skylights. Landscaped courtyards.
None of that is necessarily bad, but all of it
is obviously expensive. Five years ago I needed emergency treatment to remove
my gall bladder while on a trip to Boston. It involved five days in the
hospital before they would let me fly home. Even though I was covered by
Medicare at the time, I saw the invoice. It was for $140,000!
In Italy, meanwhile, my visit to the emergency
room was free. At one point a person with a clipboard came into the
treatment room and I figured she was doing an insurance check. The doctor
shooed her off, saying it was clearly an emergency. We never spoke to anyone
else.
Here, it seems, the money is being spent on
the technology, not the trimmings.
In the end, it was the former and not the
latter that made the difference to me. The service was as professional and as
expeditious as any in my experience. They even offered to have me stay for ten
days so they could observe me and provide continuous care. After my wife
assured them that she would give me the regular medications and keep me from
over-exerting myself, they discharged me. They also said I could come back if
things got worse.
Instead I did follow-up care with a private
cardiologist. The first exam cost €140, the second was €40 – out of pocket. And
I will likely need an angiogram in January.
The treatment in the hospital and the
follow-up care over the past four months has me almost back to my normal self.
I am breathing fine and my heart is steadily improving.
All in all, my experience with the Italian
medical system has been a good one.
Before now two things had stopped us signing
up to Italy's Servizio Sanitario Nazionale, or national healthcare
plan: when we first talked to the hospital in September 2018 about enrolling,
we learned that the rates for retired non-EU residents were significantly
higher than we expected. Our British neighbours told us they pay around €400
per year. In fact, we were told that in our case it would be €1,900.
And you pay in one lump sum for the calendar
year, with no pro-rating – so it costs the same for 12 months of health care as
it does for one. We didn't want to pay that for just four months, so we
continued in the "risk" condition.
But after this? We will sign up next month and
pay the full amount.
Useful vocabulary
ambulatorio – clinic, usually drop-in and free to all
Servizio Sanitario Nazionale (SSN) – National Health Service
Azienda sanitaria locale (ASL) – local health authority, where you can
register with the National Health Service
tessera sanitaria – national health insurance card,
required to benefit from subsidized access to Italy's public health
service
assicurazione sanitaria – private health insurance
medico di base – primary care physician or GP
pronto soccorso – emergency care
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