03.12.09
Posted in Ancona, health care
at 10:51 am
I’ve written several times about the health care system here in Italy. Our first big experience – the birth of our youngest – was fairly positive. There were some obvious differences, but the price of approximately €0.00 made the learning curve worth it. It seemed to be similar to what we experienced in America, but decentralized. You are responsible for more of your care, your record-keeping. There isn’t really a central location or doctor that coordinates everything.
So we’re now facing our second experience. I have a bump on my finger.
Eww a cyst!
It’s not a big bump, but it kind of hurts. So I figure I’ll talk to my main doctor about it. He’s a great guy – very laid back. But I’m learning that he mostly just writes prescriptions and sends you to specialists. His office is about 8′ X 12′, there aren’t any nurses (only a morning receptionist), no billing, no appointments. It’s basic health care boiled down to the bare necessities.
He agrees it should be removed. Since it’s on the skin he gives me a prescription for an dermatologist appointment.
I make the appointment and find out the doctor sees patients at the city hospital. And there’s a wait of about eight weeks. I wait and show up and pay the €16.50 only to be told that my little bump is under the skin. I need to get an ultrasound and go see a surgeon.
Back to the primary doctor. He gives me a prescription for an ultrasound and a surgeon. I go to the office to make the appointment. They tell me there’s an spot open in Castelfidardo (about 35 minutes away) to see a surgeon. The ultrasound will take about three months and I have to go to Loreto (about 1 hour away). I ask if I need the ultrasound first, and they told me to ask the surgeon.
So I head to the appointment, and he tells me to leave since I don’t have the ultrasound.
More waiting. Then I decide to call about getting an ultrasound done privately. There are two systems here – the private, cheaper system that involves long lines and lots of headaches, or the private system, which is more expensive but generally easier. I call to see about changing my appointment to a private doctor. And to my surprise, there’s an appointment available in three days here in Ancona for €65. I take it, she prints out pictures of my finger bump, types up this fancy report, and I remake the appointment to see a surgeon.
And today was my appointment. I showed up, paid €16.50, and waited to go see him. They call my name, I sign a paper, and the doctor looks at the bump. And then quickly dismisses me. Apparently they coded my appointment wrong. I need to see a surgeon who works on hands. He’s a general surgeon, not a hand surgeon. I sat there, kind of stunned that I had wasted another morning on another fruitless appointment. The good news? He’s not going to charge me for the visit!
I was struck by a comment he made. He said that if we were in “some place like Africa” he would remove the bump himself without any problem. But since we’re in Italy “we have a better system.”
Really? I’ve been trying to get a tiny cyst removed for about five months now. I’ve been to offices all over the place and no one seems to be willing to help a foreigner understand a system that Italians struggle with. I’ve learned that most people just pay extra to see private doctors to avoid this mess. And sometimes I get nervous as to what might happen if something really serious is wrong someday.
We’ve got good doctors here, but it seems like they are covered in layer after layer of bureaucracy and apathy so no one seems to get anything done.
But hey, at least it’s cheap, right?
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01.11.09
Posted in culture, family, health care, kids
at 9:55 am
Everything is cultural. Every now and then I start to think that surely there must be some universal truths that are true for everyone in every culture. Like raising an infant. There have to be some dos and don’ts, right?
Wrong! Our kids’ pediatrician is teaching us that. Around Francesca’s five month check up, she hands Heidi a badly photocopied recipe called: Diet from the 6th Month. Here it is:
Make a vegetable puree with:
one potato, one carrot, one zucchini, one onion, and either some Swiss chard or celery.
Take 2-3 tablespoonfuls of the vegetable puree and add:
2 teaspoonfuls of extra virgin olive oil
2 teaspoonfuls of aged Parmesan cheese
3-4 tablespoonfuls of multi grain cereal or baby pasta
10 grams of powdered meat or 60 grams of pureed meat
And so once a day for lunch, that’s what Francesca eats. For dinner, we substitute ricotta cheese instead of the meat. Starting with the seventh month we add fish instead of meat. And from seven and a half months we add ham. And then month eight brings beans (surely we’ll notice the effects of that!).
We raised three kids in America, and I don’t ever remember boiling an onion or Swiss chard for the babies lunch. I can’t think of any pediatrician that recommends ricotta or Parmesan cheese for a six month old. But we tried it, and she loves it. No gas or tummy aches from the onion. The pureed meat is just fine.
And it all proves that everything – even what we feed our kids – is completely influenced by what everyone around us does.
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10.29.08
Posted in health care
at 5:15 am
We had to take our oldest in for a doctor’s visit so he could do fencing. It’s mostly just a checkup, but this time she asked us if Lance had ever had an appointment with a cardiologist, or an EKG or anything. Which was kind of scary for a minute, but she assured us everything was OK and she just wanted to make sure nothing was wrong. She printed out the little form we need to take in to make the appointment, and I smiled knowing that it would be free because we’re a part of the Italian health care system.
I called the hospital to make the appointment this morning. I read all the numbers on the form, and she started typing it all into the computer. She warned me there could be a bit of a wait for the visit. And then she asked me how July 24, 2009 sounded. Seriously. Unbelievably, I happen to know we won’t be here around then, and said it would be better to wait. So I made an appointment for my son to see a cardiologist for October 1, 2009. An eleven month waiting period! Which really would have only been nine months, but still!
Different politicians have ideas for fixing the American health care system. I’ve been mostly pleased with what we get here, but would the average American be willing to wait that long for an appointment?
My premium for the year to be in the Italian system is around €400 for the whole family. I guess you get what you pay for!
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06.15.08
Posted in health care
at 9:52 am
We had already dipped our toes into the waters of the socialized medical system here in Italy. A couple of routine checkups, funny rashes on the kids, that kind of thing. Having baby #4 was a headlong dive in. Health insurance is the US is sky high, if you can even afford it. Those who hear that we pay about $600 per year to buy into the Italian system think that Italy must have found the solution. But I think you get what you pay for.
Overall, we had a great experience. The nurses were more than friendly, and seemed to be more available than I remember the nurses were with our other kids. The doctors were often in a rush when they made their daily rounds, which seemed about how I remember it in the US. But when there’s no bill coming at the end of your stay, there’s less of a rush to cram all of the treatments and all of the tests into a short time frame.
But that’s about where the similarities end. We were given a list of supplies we needed to bring with us to the hospital. I was surprised at what wasn’t included. You bring your own nightgown and robe. You were on your own to bring many of the supplies needed for personal care after the baby was born. You also bring clothes for the baby. Silverware wasn’t included – we found out you’re supposed to bring your own. And the meals were pretty scant. Breakfast was two slices of dry pre-packaged toast, and a hot drink made with barley and milk. And every room but one had at least one other person in it. The larger rooms had three women!
So on one hand, you have the US system. It’s expensive, but looks like a nice hotel compared to what we had just experienced. And you have the Italian system, which is good care but absolutely no frills.
If the US were to ever switch to something like that, I have a feeling that a lot of the frills would have to be cut. People would be more responsible to provide some of their own care. And I’m not sure that everyone is willing to make that sacrifice.
The issue of health care is a big one in the US right now. The system as it is can’t continue, but how do you fix it? When will the most powerful nation in the world start doing what it takes to take care of its citizens? Will people be willing to sacrifice the little amenities (like silverware!) to make things less costly for everyone?
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12.13.07
Posted in culture, health care
at 3:34 pm
I had to take Lance & Chloe to the doctor today. They both needed a certificato medico in order to be able to play the sports that they started three months ago (we’re a little behind). This was the first time for them to see this doctor, so I kind of wanted to see what she was like.
I’ve been amazed at how much an Italian doctor gets done with so little. There’s no receptionist. There’s no insurance/billing department. There are no nurses. It’s the doctor, by himself in his office, and a waiting room. People wait, and one by one (in the order of arrival) they go see the doctor.
The exam was quick and painless. Height, weight, say ahhh. But the doctor turned to me at one point and said very seriously, “Does he go poop every day?”
I promise I only giggled a little. But Italians take matters of health seriously, and so I responded in the affirmative. I don’t think an American doctor ever asked me about poop. I might bring it up if I had a problem, but only if I really had a problem. In general, I think Italians are way more open about health stuff. I’ve seen old ladies rebuke strangers for not putting on a hat when it’s cold. Jason has been scolded for not dressing warm enough because of his kidneys (how do you know if your kidneys are cold?). And opening a window on the bus is enough to get a person booted off. It’s actually written in the rules that you have to get permission from everyone around if you want to open a window – drafts make people sick.
And so I just have gotten used to people asking me about my personal health issues. And I tell doctors about the frequency of poops. And I sure don’t leave the house without a scarf – who knows what you might catch with your neck exposed.
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