LIFE: An Apple a Day

SARONNO, Italy – A few weeks ago I had to go back to the National Health office and have my “pink card” updated. A pink card is a list of codes related to tests and treatments connected to a person’s chronic diseases. It is used by family physicians when they are writing prescriptions to indicate that the person receives the test or medication gratis. Otherwise, in my case for example, I would be required to pay what is called a “ticket”, a surcharge for every prescription or test, which for me would be $2.00 per prescription.

 Entrance to Gaslini Children's Hospital, Genoa, Italy

The latest chronic disease to be added to my “pink card” list is high blood pressure. I’m happy it’s only that. I’ve had some pretty scary tests the past few months, including a PET scan. The idea of having a radioactive substance injected into my body and then traced by sliding me into the maw of what looks like a space capsule, well, let me say this, one of my Italian daughters had to go with me and hold my hand. So much for my frontier, independent, I can handle this myself spirit.

When I became a legal resident, I was issued a National Health Card but never thought much about it. I just continued to make private appointments just as I had always had in the United States. But then my rheumatologist asked me why I didn’t use the National Health System (Mutua) instead of paying to see her privately.

“It’s the same,” she said. “When you call to make an appointment with me and they ask you if you want a private or a Mutua appointment, just tell them Mutua. "Nothing changes," she said, "it's always me and it's always this office, it's always this hospital and you won't have to pay anything.” So that's what I did.

Some of the doctors and researchers at Gaslini Hospital, Genoa, Italy

I have had CAT scans, sonograms, MRI’s and all sorts of specialized exams over the years and have paid for none of them. I've spent a week in the hospital, have had physical therapy, eye exams, visits to the dermatologist and the list goes on, all covered with no additional out-of-pocket costs for me now that I am officially retired. The system really works, and it works well. 

There are a couple of things I really like about the Italian health care system. One is that you keep your own records, test results and X-rays, and pick the doctors and the care facility, be it public or private, you want to go to. It wasn't like that when I lived in San Francisco. I had to travel across the city to go to the HMO that was listed on my company’s plan. Not only was very inconvenient but I had no choice of anything. I had to be satisfied with the HMO facility and the doctors who worked for that HMO.  

I thought perhaps things had improved in the years I've been gone so I was shocked the other day when an American friend of mine told me that she tried to renew a prescription and the pharmacy told her the insurance company would not allow it. The insurance company would not allow it? The pharmacy told her the renewal had been refused. The insurance company, or better yet a clerk at an insurance company gets to decide what prescriptions can be refilled and which cannot? And America is OK with this? And the latest scam is the drugstores in her area (Buffalo, NY) refill your prescription on their own and then call you to come and pick it up. I can only imagine how many people feel obligated to pick up prescriptions they may not even need any more. It's disgraceful.

 Laughter is still the best medicine

Americans are against a single payer health care system where you and your doctors make the decisions because of why? Have they forgotten what the word 'choice' really means?

This is the same friend who told me her primary care physician 'gets mad' if she wants to see a doctor outside of his medical group. Besides, she said, they don't like to share information with other doctors who are not part of their group. When I suggest she might want to keep her own records and see whatever physician she damn well pleases she told me she doesn't want to ask for her records because her doctor will be upset. The doctor will be upset? So?

Gaslini Hospital - They Saved Him

I think some Americans are reluctant to embrace a national health care system because no one tells them how these things really work. The insurance companies hire lobbiest to lobby Congressmen to oppose the system simply because they want to keep the status quo. It's in their best interest - but it is not in America's best interest, not by a long shot.

With a national health plan you eliminate the middle man - the insurance company - and when you do that health care costs go way down. Not only that, but then you get to decide where and when and who takes care of you not a clerk in an insurance company who is under orders to cut costs because the company is more concerned about their quarterly profits than your health  - and I don't know about you, but  for me that’s what health care choices are really about.  

I actually do know a thing or two about insurance companies, I've worked for several in my day. I have heard with my own ears insurance salesmen telling clients that when their insurance policy was paid up they had to cancel it and get another, because it was only valid if they were paying on it. I have seen with my own eyes two sets of rate books, one for blacks and one for whites, used to calculate the amount of money a policy holder could borrow against their policy. Guess who got the lower rate? I have seen a lot of things when I worked for insurance companies, and none of them were ever in the interest of the policy holder.  

Is the Italian health care system perfect? Not by a long shot. It's only Number 2 in the world according to the World Health Organization. Perfect no, but then again, what is?

LIFE: The Italian Health Care System

There was a postcard from my local hospital in the mail yesterday with the scheduled date for my next mammogram. They ask only that I call and cancel the appointment if I can’t make it so they can put someone else in that time slot. Regular mammogram screening is part of the Italian government’s preventive care system.

When I became a legal resident, I was issued a National Health Card but never thought much about it. In my mind nationalized health was the nightmare my daughter experienced when she lived in London. Long waits, bad doctors, third world care. So I just continued to make private appointments just as I had always had in the States. But then my rheumatologist asked me why I didn’t use the National Health System (Mutua) instead of paying to see her privately.

“It’s the same,” she said. “When they ask you if you want a private or a Mutua appointment, just tell them Mutua. It will save you money.”

And it has. Because I have a chronic disease, (rheumatoid arthritis), anything and everything related to that disease is covered by the insurance program and costs me nothing. Even if I didn't have arthritis, all medical visits would be free because we don't pay for medical appointments.

I have had CAT scans and MRI’s and all sorts of specialized exams over the years and have paid for none of them. I've spent a week in the hospital, have had physical therapy, eye exams, visits to the dermatologist and the list goes on, all covered with no out-of-pocket costs for me. My only expense is for one non-arthritis related medication. That prescriptions now costs me €2 ($2.50) a month instead of $28 which is what I was paying for it back home.

And if you think the drugs are cheaper because they are churned out in some dank subterranean grotto, they are from the same high profile, multi-national drug companies I learned to love and depend on when I lived in the U.S.A.

One of the things I like the best about the Italian health system is that you keep your own records and X-rays, and pick the doctors and the care facility, be it public or private, you want to go to.

I recently had to make a couple of appointments at my local hospital. What I found was that for one exam I could get an appointment faster through the National system and for the other, it was faster to go private. So that is what I did. I used the National system for one and paid for the other. It’s that flexibility, and the fact that the choices are always mine, that, in my opinion, makes this system so good.

Another thing I like is that the doctors take their time. They talk to you. They want to know how you are. There is no hurry because appointments are scheduled a half an hour apart. And do I dare tell you that if you can’t get to the doctor the doctor will come to you? It’s true. Italian doctors make house calls. Have an emergency? Your doctor out of town? The Guardia Medica is on-call 24 hours a day, and they will come to you as well.

In the world wide ranking of health care systems, Italy is rated No. 2, after France, but personally I think the Italian system is better. Basically they are the same. The difference is with the French system you have to pay for your services first and then the government reimburses you, while in Italy we don’t pay. Both systems are similar in that anyone who lives in France or Italy legally is covered.

So who pays? The people who use the system. Taxpayers. A percentage of income tax revenue is allocated to health care. And for all the grousing Italians like to do, I have yet to hear anyone complain about the health care system, or having to pay for it because everyone uses it, and everyone benefits by it. Especially me.

Photos courtesy of the Rivista di Informazione Sanitaria della Regione Lombardia, a monthly consumer Health magazine published by the Region of Lombardy.