When Pennsylvanian Timothy Bloom moved to Italy in 1993, one of the cultural adjustments required was getting used to state-provided health care. Sixteen years later, as his relatives back home debate a proposal for a similar system in the U.S., Bloom has some advice based on first-hand experience: In his opinion, the positives of the state-run system outweigh the negatives.
“Most people get pretty decent care, and no one is completely abandoned,” said Bloom, 43, a professor of English at the University of Urbino. “I think overall it works.”
As opposing forces wage a heated and emotional debate over the issue in the U.S., interviews with ex-pats and native Italians in Urbino with experience in both systems provide insight into what such a change could mean. In general they praised the ability of the nation to provide quick and competent care to all of its citizens, regardless of income, and considered the extra cost in higher taxes — the longer waits for some forms of care — a good exchange.
Italians, like most Europeans, consider health care a national right, not a luxury, they said. And news reports that 45 million Americans had no health care last year, or that families can go bankrupt paying for critical health care, was unacceptable to those interviewed.
The concern for quality health care may be one reason the current Italian system, Servizio Sanitario Nazionale, or SSN,, was ranked No. 2 in the world by the World Health Organization in 2000, the last year such a study was completed. The U.S. was ranked 37. Turkey and the U.S. currently are the only two industrialized nations that do not provide national health care.
SSN is based on a traditional universal model, where the state is responsible for providing accessible healthcare to all of its citizens. Primary care physicians work at local clinics where they treat common problems and screen for more serious illnesses. There is no private sector option for primary care. If a patient needs a specialist, he is referred to one in the Italian system, and that is where waiting times increase. There are private sector specialists, but their costs are not covered.
Prescription medication is also covered by the state. The process is simple, much like in the United States: If a prescription is written, the patient redeems it for the proper drug at a pharmacy.
Paci Luigi, a pharmacist here since 1975, said he fills around 100 prescriptions a day, mostly for the elderly. He noted that the government will cover any generic prescriptions; however, name-brand prescriptions come at an out-of-pocket expense.
While citizens pay nothing when treated, costs are collected on an on-going basis through higher taxes. The Italian system is financed by general tax revenue combined with an additional healthcare tax. On average, Italians are taxed around 45 percent of their salaries.
Bloom, 43, thinks the price is worth the benefits. For the last six years his daughter has been battling an on-going health problem and is no stranger to the hospital. “I would say we’ve had excellent care,” he said. “It’s probably as good if not better than what she might get in the states.
Andrea Luminati agreed with Bloom. An Urbino native who moved to Los Angeles when he was 18 to pursue a degree in advertising at Pepperdine University, Luminati, 44, stayed in the states for the next 20 years before retuning to Italy in 2004.
While in the states Luminati first worked for large companies that provided healthcare benefits, but later started his own business and provided his own health insurance which cost $300 per month. At the age of 38, just one month after getting his own plan, Luminati was diagnosed with kidney stones and hospitalized for three days. He said the final bill totaled more than $20,000.
“If I hadn’t purchased that insurance in the states, it would have been a huge (financial) blow,” he said.
Once back in Italy, Luminati had another serious health problem, this time a thyroid issue. He said the public system operated in Urbino gave him prompt and excellent care, from diagnosing the problem, running specific medical tests and then providing the proper medication. He paid no money out of pocket.
But Luminati added that state provided care does have some bugs, which get larger and more onerous as the community you live in grows in size.
“You have to look at the Italian healthcare system almost in a city by city basis,” he said. “In Italy, in a smaller town the healthcare system works very well because it’s smaller, there’s less people. (But) in Milan or Rome it’s a whole different ballgame.” He said bigger cities have longer lines for routine care and longer waits for surgery. He said newspapers often run stories detailing this problems and even sanitary issues.
Bloom agreed, adding that many Italians are unsatisfied with the system, most particularly with waiting times.
“I’ve had a family member who had a serious health problem and she had to wait, I think longer than she should had to get the necessary care,” he said. “I’m not sure if she would have had to wait so long in the states.”
Bloom added many Italians believe the recent wave of immigration — much of it illegal — is a reason for some waits. “A lot of (illegal) immigrants use the hospital for basic care because they often don’t have a regular doctor,” said Bloom. “People are worried that it is putting pressure on the system and people are worried because they have to wait in line.”
According to the European organization Active Citizenship Network (ACN), in 2005 around 5,000 Italians filed requests for treatment abroad, most from southern regions.
A nationwide inspection of public hospitals was conducted in January 2007 after multiple reports of poor hygiene and unsafe conditions. Less than half were given a clean bill of health. Thirty-six percent were reported for breaching administrative norms, 17.4 percent for breaching building norms and 7.5 percent for breaching hygiene and cleanliness norms. Regions such as Calabria, Lazio and Campani showed to be the least hygienic and were said to have some Third World features.
According to Luminati, many Italians often seek private care to avoid long waits.
“You’ve got a choice, you’re not stuck with socialized medicine, if you’ve got the money you can go privately,” said Luminati. It is estimated that roughly 35 percent of Italians have some sort of private care.
Elvita Redavid, 27, of Urbino, recalled her last experience with the healthcare system.
After suffering multiple hip and knee injuries, Redavid traveled north to seek private treatment. From experience, Redavid estimated that a vast majority of Italians prefer private facilities over public because of long waiting lines for specialized care in the public sector. “I just felt more comfortable and safe with a private specialist,” said Redavid.