My parents were visiting us recently, and had come down with persistent colds that were beginning to feel like sinus infections because of how long they had dragged on.  That’s a condition best judged by a doctor, and their own doctor was on the other side of the world, in the US.  What to do?  We walked 5 minutes around the block to visit my doctor here in Padova, to ask his advice.

Backing up in the story a little bit, a lot of people are curious about how health care works over here, perhaps imagining that it’s a gigantic, scary bureaucracy.  How do you even choose a doctor?  Are they assigned by the government, or something?  No, actually – when you move to a new town, you can choose from a list of family doctors, or “medici di base” that accept new patients.  Usually there are a few in your neighborhood, within walking, or at most, cycling distance.  Not having any other information to go on, I’ve always chosen them for proximity, so that I can just walk over if I don’t feel well.

Some doctors require an appointment, but most that I’ve dealt with here  do not.  They have office hours that are posted both on line (although those can often be out of date) and at their actual office.  The hours are sometimes fairly limited – a few hours in the morning, a few in the afternoon.  Another important consideration is that a number of doctors, in order to be closer to more people, will have two offices, and perhaps have morning hours at one, and afternoon hours at the other.  It’s important to check where they are in order to avoid going to the wrong place!

Rather than being in a modern, fancy looking office building, most family doctors’ offices are in converted apartments.  That, combined with the very spartan decor in most Italian doctors’ offices, can make them look a bit dingy.  All things considered though, I don’t go to there to hang out and relax, so I’ll take cheap and plain to fancy and very, very expensive.

Generally, there is no paperwork to fill out, since there are no insurance claims.  The doctor might type in that you visited, and for what, and might have to type up a prescription, but as the patient, it’s very rare that you have to do anything other than turn up and let the doctor look at you.

It turns out that my parents were fine: the doctor agreed to see them, and prescribed antibiotics which got them back on their feet in short order.  We probably waited all of 10 minutes in the waiting room to see him, although we were lucky on that count.  My wife and I had one former doctor who always had an interminable wait due to the large number of elderly patients she had.

Thankfully, I don’t have much personal experience with problems more serious than sinus infections, but the quality of care in general seems good, and the doctors and nurses skillful and knowledgeable.  A constant is the lack of “extras”: everything is fairly plain and a bit austere, if functional.  Unless you pay extra, you’ll likely share a room in the hospital, and there won’t be a TV.  Some elective surgery can have long waits, if you opt for the public system.

One of the things that  I like about health care in Italy is the parallel, private system.  Italians complain about having to pay for quicker access to care, which is not a wholly unfounded observation.  However, since the competition (public health care) is free, it means that doctors taking on private patients simply can’t charge too much without driving away most of their patients.  A few years ago, for a bad cough, I got a chest x-ray and a consultation with an ear, nose and throat specialist for under 100 euros, out of pocket.  Try that in the US!

A note on “free”: no, of course it’s not really free.  You pay for the health care here via your taxes.  If you’re out of work, though, you don’t pay into the system, and you never have to worry about being able to take your child to a doctor, even if the lack of a job creates plenty of other worries.  And, when totally up the numbers at a countrywide level, the United States spends nearly twice as much as Italy (World Bank data), even if Italians actually live a bit longer than Americans.

Speaking of sinus infections, a few years ago I was back in the US at Christmas time, and got one.  I paid something like $150 out of pocket to see a nurse practitioner and for the antibiotics I needed.  Almost ten times what my parents paid for the antibiotics they got here in Padova.

All in all, while health care is not perfect here in Italy, and there are things I think they do better in the US, the system is pretty good in a lot of ways, and the fact that it manages to be both cheaper and less bureaucratic than the US system should give Americans real pause for thought.