March 13


Healthcare in Italy: U.S. versus Them

By Rick

March 13, 2013

hauntedhouseAbout a year ago I was in the market to buy health insurance that would cover me in Italy. The insurance company required me to have a physical exam in order to pre-approve the policy, a standard procedure.  This is how I wound up at a clinic for the criminally insane in the middle of Trastevere.

“Are you sure this is the place?” I asked my girlfriend as we were wandering through the side streets, looking for the doctor’s office.

“I guess so.  It’s the right address, but…”

She was obviously thinking the same thing that I was.  The building in front of us looked more like a haunted, low-income housing project than a medical facility.  The razor wire on top of the wall is what gave me this initial impression.  There were, in fact, some hypodermic syringes scattered about the grounds, but it seemed unlikely that they had been used for their intended therapeutic purposes.

To an American expat, Italy can often seem like a country of extremes.  The extreme beauty of a Bernini fountain right next to a big pile of uncollected garbage. Prestigious universities filled with learned professors, but sorely lacking resources and adequate classroom space.  Physicians that are highly skilled, but trapped inside facilities that were already outdated when they were built in the 1950’s.  It can be hard to reconcile the juxtaposition of these contradictions, especially for someone who grew up in place where most everything is “senza infamia e senza lode.”

The Doctor is In(sane)

“The doctor will see you now,” said the nurse.

I followed her down a short hallway, ignoring the moans coming from behind closed doors.  I was led into a small room where a middle-aged man with long greasy hair was sitting next to an open window.  He was wearing a white lab coat and his left hand hung over the window sill, clutching a smoldering cigarette, which allowed the majority (but not all) of the smoke to drift outside.

Dr. Frankenstein, I presume?

With his right hand he was pecking away on an old Commodore 64 computer, although I couldn’t tell if he was updating medical records or playing Briscola.  The stethoscope around his neck gave me a sinking feeling that this character was the alleged “doctor” who was to perform my exam.  He glanced up at me momentarily and started coughing spastically as only a life-long smoker (or someone with tuberculosis) can do.  Then he proceeded to light another cigarette as he finally stood to greet me.

“Sit here,” he commanded, through a blue haze of smoke.  I could only admire his sense of economy with words.  Bedside manner was apparently not his strong point.

As I sat on the examining table, I began to scan the walls for the customary display of framed diplomas and/or specialty certificates.  I saw no such thing.  Instead, there was a complicated electrical device with wires coming out in every direction which took up most of the space in the tiny room.  A low, static hum emanated from its bowels, glowing ominously, and it looked like a prop from a Boris Karloff film.

I quickly abandoned my search for his medical credentials and sought out potential emergency exits.  He had the door blocked, but I had a clear path to the open window.  Unfortunately we were on the second floor.  Still, I had made up my mind to take my chances with the fall if he tried to hook me up to his Frankenstein machine.
Hannibal2I needn’t had worried.  The “exam” lasted all of four minutes, three of which were spent waiting for his coughing spasms to subside.  He asked me a few basic questions, started to take my blood pressure, but then changed his mind and just checked my pulse instead.  Apparently he was only verifying that I had a pulse, because there’s no way he could have determined its rate or regularity in the two seconds that he touched my wrist.  In any case, he promptly signed the form required by the insurance company to confirm that I wasn’t yet dead or in the act of dying.

But now here’s the interesting part: I reached the reception desk again and asked the nurse how much I owed the doctor.  She gave me an odd look, barely suppressing her laughter, and then said, “You owe us nothing, of course.  Buongiorno, americano.

As she walked away, I turned to my girlfriend to make sure that I understood correctly.  “Nothing? Not even a co-pay or a deductible?”

“Huh? What are those?” she asked me.

Good question.  How do you explain the US healthcare system to a non-US citizen?  I was actually part of that system up until a few years ago and I still struggle to understand it.  We pay extortionate premiums, yet are still expected to contribute significant co-payments and deductibles.  Policies also have maximum annual and lifetime benefits, which at first glance might seem quite generous—until you begin to calculate the cost of one hospital stay.staying healthy in Italy while on vacation

And if that were all, it would almost be OK.  But the final indignity is that we are forced to constantly fight with these companies to which we’ve already paid enormous fees to prevent them from denying coverage outright. They have a phonebook-sized list of excluded illnesses.  Pre-existing conditions are never covered.  They have an army of employees who are devoted to finding reasons not to cover any given medical procedure or drug.  These folks are well-trained and have had lots of practice—you have no chance of defeating them or finding a loophole that they haven’t already thought of.

This is just what a sick person needs: to spend what little energy they have to combat against the people who they’ve paid to help them.  As I write this, I’m struck by how ridiculous it sounds, and yet I’m all too familiar with the system to think otherwise.

Healthcare in Italy

I have since seen a few Italian doctors who are nothing like the mad scientist that I encountered in Trastevere.  Most medical offices in Italy are very modest by US standards, but clean and staffed by extremely competent personnel. They don’t have leather sofas or satellite television in the waiting rooms; no valet service or complimentary pedicure while you wait.  But here’s the thing: you are treated like an actual person and not like a set of organs in possession of a wallet.  “How can we help you?” is the opening question, instead of “What type of insurance do you have?”

I have a lot more to say on this topic, but I’ll leave it for the comments section.  I’ve already taken up too space with my rant and I want to provide some useful information for expats in Italy in need of healthcare coverage.  My discussion primarily involves Americans, because if you are an EU citizen, then you’ll have different choices, although most of this information will apply to you, too.

Options for Expats

If you have a private insurance policy from the US, then technically you’re covered in Italy.  The problem is that you’ll likely have to pay up front for your care while in Italy, and then ask to be reimbursed by your US carrier.  This is good news and bad news.  The good news is that your out of pocket costs in Italy are going to be significantly less than they would have been in the US.  But of course the bad news is that you’ll have to fight endlessly with your US company who will look for every reason to not pay you back.

If you are planning to stay in Italy for a while, but less than a year, one option might be traveler’s health insurance.  These policies are quite cheap, but are not intended to provide comprehensive coverage.  In other words, they don’t cover every little thing or routine exams, but they’ll keep you from running up huge medical bills in the event of some unfortunate long-term illness or serious accident.  It’s easy enough to buy these online, and it also satisfies the requirement for your Schengen Visa.

If you’re staying longer, you may elect to purchase “expat insurance” through a foreign insurance company. The main advantage of this type of policy is that treatment is unrestricted and you can choose any doctor, specialist, clinic, or hospital in Italy.  Compared to the Italian state-sponsored system (SSN), it’s expensive, but compared to equivalent coverage in the US, it’s a steal.

This is what I did, and although Italians consider this to be an unnecessary expense, I found it to be an incredible bargain compared to what I paid back in the US and it gave me the peace of mind that I wanted.  My policy was issued by Helvetia, a Swiss company, for the low price of €1,296 per YEAR!  My former US policy cost me that much in two months, and of course it contained all kinds of exclusions and disclaimers. The funny thing is, I almost had to beg the salesman to sell me the policy. He tried to talk me into buying into the state system, thereby cutting himself out of a commission. Go figure.

Speaking of which, if you are a legal resident, you have an opportunity to participate in the national healthcare system.  This is called, voluntary subscription (l‘iscrizione volontaria) and it’s a real steal at less than €400 a year—even less than that for students and au pairs (you can calculate your exact cost here, and it can also be found on my Helpful Document page).

Italian health insurance card Français : Carte...
Italian health insurance card

The only small catch is that the premium is based on the calendar year, so if you buy it in November or December, then you’ll have to renew again in January.  Just something to keep in mind.

Here is the website with all the information, in both Italian and English: Assistenza Sanitaria

A quick word or two about pharmacies and medications.  Pharmacies in Italy operate totally differently than in the U.S.—there are no big drugstores like Walgreen’s or CVS.  Opposite to the US system, in Italy OTC drugs are quite expensive while prescription drugs are either free or very cheap (provided that they were prescribed by an Italian doctor, of course).

A pharmacist must dispense almost every type of medication here, including things as simple as Tylenol.  Consequently, the costs of these items are higher. So if you take any regular meds, I’d suggest that you bring enough to cover you for the entire length of your stay, if possible.  If not, then go to the Guardia Medica and ask them for assistance.  This is the direct link for the branch in Rome: Guardia Medica in Rome

Then again, you’re in Italy, so you’d do well to observe the words of Hippocrates and just “Let food be thy medicine.”

So that’s the basic information about healthcare in Italy.  One final word of advice: don’t get sick.  But if you do, just make sure that your doctor has his credentials clearly displayed–and always know where the emergency exits are located.

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About the author

Living in the Caput Mundi and trying to decipher Italian culture for the English speaking world.

  • Interesting article and fascinated that Italy’s healthcare system was a positive for you. When visiting Italy with family, our mother became very ill in Sorrento. The ER looked at her and pushed us out the door (3am). Instead of traveling to Greece as planned, we took the first train to Rome. After several hours at the hospital there, she came stumbling out (they wouldn’t allow any of us to accompany her) of a locked door (as they all seem to be). She still didn’t know what was wrong. I took her to the door she exited from and waited until another patient exited; we pushed our way in as they tried to make us leave. Finally the ER doctor allowed us in. He explained she had shingles. No meds or anything. He advised us to go to a pharmacy. Fortunately, the owner of the apartment we found was a doctor. She was unhappy the doctor didn’t prescribe anything for the pain. She drove me around town and used her documents to prescribe drugs. Thank God for her. I’ve been to Italy several times since, and I never leave the US without travel insurance and medical evacuation.

  • Rick´s rome, I found your article really interesting, thank you very much!!!!! it help me a lot. I am trying to enroll the NHS but my only problem is how to choose a doctor that speaks English, they told me I have to choose one of a list and that person will be my general practitioner. I hope you can help me… I am in Milan. sorry for my English my native language is Spanish : )

  • I was surprised at the lack of irrational rants (billynnn notwithstanding) on this subject that is very touchy for most Americans.

    Every single industrialized democracy other than the USA ensures that its citizens have access to health care, affordably. Not a single one of them has ever, or would ever, choose to emulate the US system.

    I can only assume that this is lost on most Americans because they think that these nations don’t have elections or freedom? There are many hot-button issues on which politicians campaign in Italy and other European nations… immigration, taxes, jobs… you will never, ever find a politician – even from a minor party – in any of these countries campaigning to replace their system of socialized medicine/universal health care with something like the US system. If socialized medicine was so horrible, one would think that there would be politicians loudly proclaiming their plan to scrap it and install the US system instead!

  • Thank you this is very informative. I am thinking of spending part of the year in Italy and part in the US. So I am not sure if I should take our a traveler’s insurance or pay for the government Italian Insurance

  • This article is rather unfunny: from the first part emerges the lack of objectivity of the author. Take a look at Sicko – 2006 by Michael Moore, regarding health care Italy was ranked 2nd (if I remember it correctly) all over the world. The only negative part is that southern part of Italy (Terronia, starting from where you live) is a millstone round our necks so peole go to north to be visited.

    • Hi Paul, and thanks for your comments. But after reading what you wrote, I’m left to believe that, 1) you didn’t read the entire post; or 2) your English is as bad as my Italian. Perhaps both, because at the end of the article I clearly defended the Italian healthcare system against the American one. You mentioned some stats that, while over 10 years old, are still fairly accurate. My experience in Trastevere is a true story. But as I mentioned in the second half of the article, it does not reflect the system overall, in my opinion. Regarding the south, yes, it’s a shame that those regions have been given less importance by the national government forcing their citizens to seek healthcare up north, far away from their homes. In fact, I don’t think Italy can really claim to have a good healthcare system if those stats are only true for the northern half of the country. Thanks for sharing your opinion. Rick



        • Correct me if I’m wrong but Rome IS in Italy, right? So should I see a doctor (or 2 or 3) in every hospital in the country to get an accurate picture? What’s your point, exactly?

          • I think as a general rule, comments in ALL CAPS can safely be ignored. It is practically a religious faith among most Americans that US health care is the best, period, how dare you say anything bad about my mommy.

            Just substitute “HERETIC!” for whatever blather billynnn posted.

  • Rick, This is a great article. I really enjoyed it and also learned quite a bit. The story of the visit to the Trastevere doc was hilarious although admittedly scary. I have heard these stories from some of my Italian friends. Thanks again for sharing!

    • Thanks Margie! Yes, the doctors in Italy are generally very good, but there’s always exceptions, of course. The majority of US expats that I’ve spoken with remark about how much time the docs spend with them versus in the US. The facilities, however, not so great…it’s hit or miss…mostly miss. In the end, I suppose it boils down to what you feel comfortable with. Grazie ancora!

  • I’ve had nothing but the best experiences with healthcare here. You are right: Caring people who take their time with you. I have been surprised at the lack of paperwork (few forms to fill out) and also surprised to actually receive written reports and all medical records, including x-rays, to retain myself and cart along to future appointments as needed. There is a lot of personal responsibility, too. Need a blood test? Go have it done and email the results to the doctor. But dealing with my insurer in the States is a pain.

    • Yes, I forgot to mention that you retain your own records, x-rays, etc. Another important difference. But you make another great point: in a country drowning in bureaucracy, there’s surprisingly little when it comes to healthcare. As it should be, in my opinion.
      Thanks for the great comments…ciao!

  • Hi Rick,

    I am moving to Italy initially for 3 months and so therefore I’m reluctant to take out health insurance until I know if I’ll be there for longer. If I suddenly needed to go to the doctor, say to get antibiotics for a bad cold, can I just turn up at a doctor’s office and sign up, and obviously pay for the visit and prescription then and there? What is required? In the UK, it’s that simple to sign up at a doctor’s surgery if we have their equivalent of a codice fiscal (or National Insurance number) and fixed address. Thanks!

    • Ciao Rowena! Yes, for minor needs you can just go to the doctor and he/she will treat you. Technically, they can ask you for 50 Euro for an office visit, but many won’t (and generic drugs are free if prescribed by a doctor). Nothing is required, although you might bring some form of identification/UK national insurance nummber. And if they do charge you, ask for a receipt–you might be able to be reimbursed back in the UK.

  • I lived and worked in Italy for 14 years. The first 2 years were as a student. I never once purchased healthcare insurance. I was always taken care of while visiting or as a resident. As a consequence I missed all of my adult years of understanding the healthcare system in the US. It’s shocking how healthcare is not considered a citizen’s right here in the US.
    Did you find your healthcare insurance of use in Italy? It’s always nice to hear other expat’s stories.

    • Ciao Jody! I share your shock and disappointment with the so-called system in the US. As far as Italy, in retrospect I think that the private insurance was an unnecessary expense. But having been conditioned by the US system, I simply couldn’t make the leap of faith right away and believe that I’d be covered. I’m slowly getting over that, and so next year I’ll probably just go with the state sponsored system.
      Thanks for sharing your experience and confirming that I’m not alone in this disappointed realization. Ciao!

  • Rick thank you for this information. I am using it for my final project n my Health Information Management class. I’m doing it on Healthcare in Italy. This was great information thanks once again.

    • Glad you found it useful! Feel free to ask any follow up questions that you might have. If I don’t know the answer right away, I probably know where to find it. Ciao!

  • no doubt you had met such us “insane” doctor…well, lucky you the emergency exits were not locked by a big chain…(reference to your article on the web!)

    just be less skeptical about italian healthcare, it surely can be improved. but you know that not all doctors are acting the same way. thanks for stating and recognizing it in your article.
    and thanks for sharing useful info and opinions about this theme

    keep on sharing

    • You’re welcome, Matteo, and thank you for your comments. The story about the crazy doctor is 100% true, but as I mentioned in the article, I am generally in favor of the healthcare system in Italy. No, it’s not perfect, but at least people are treated fairly and with compassion. It is a very holistic approach instead of treating patients like a list of symptoms and/or diseases. Ciao!

  • Thank you so much for this! I am currently (illegally, whoops) working as an Au Pair and am trying to get my TEFL so I can return here (to work legally) in the fall- insurance is obviously a main concern of mine! This post has helped me understand better than any Google search has for the past 5 months- thank you!

    • You’re welcome, Mary! Yes, if you get your visa, then your options will include the SSN (national health service). But you can also buy expat insurance that is cheaper than the one that I bought. It can be as low as 800 per year.












        • Yes, I’m always amazed by the level of racism expressed by uneducated Italians, such as yourself. It’s too bad, because 99% of Italians that I have met are polite and gracious to both foreigners and fellow countrymen from other parts of Italy. Yet idiots like you insist on trying to give all Italians a bad reputation abroad.

          From your comments it’s obvious that; 1) your English is terrible, my two year old SICILIAN daughter speaks better than you write, and 2) you didn’t even bother to read the entire article. The second half of it confirms the quality of Italian healthcare. But of course, you wouldn’t know that, because you never made it that far before going on a senseless rant about nothing.

          You see, it’s morons like you that makes the rest of Europe feel nervous about the future of Italy. Unfortunately, it seems that the most ignorant voices shout the loudest…which, by the way, is the same as TYPING YOUR ENTIRE COMMENT IN CAPITAL LETTERS!!! LOL!!!!

          Oh, well. At least I find some comfort in knowing that you’re the obnoxious minority.

          By the way, you’d better upgrade that Commodore 64 of yours…you posted the same comment twice.

        • Dear billynnn,

          It seems to me that you totally missed Mr. Zullo issues.
          When the wrote about Commodore 64 he clearly made some humor. infacts in photo we can see a centrifuge for separating blood elements in specimen tubes, that it is old but still useful as is. No need to buy a new machine that spins round and round if that one is doing tirelessly its simple job.
          And I spotted also an electric supply that looks like de-fibrillatiing machine, again old, but I think no necessary to buy a new one if that in photo passed regular maintenance.

          As for nothern hospitals Vs south hospitals I not agree with your claims of superiority of north.
          I live in Naples and except the fact region Campania totally messed up with Health budgets in the last 30 years and nowadays trying to resolve situation by reducing number of local hospitals and services, and the fact it requires variable amount of time to obtain visits for medical specialized health tests, I can’t complain with hospitals and doctors in general here in the south, despite of TV news pointing so many times on situations of bad healthcare in south of Italy.
          But these situations are the exception, not anyday common situation and as a proof of what I am saying it is right the fact that these situations are so rare enough to be noticed by the TV news in order to gain audience.
          And believe me… I am enough old and I have a family enough big I can testimony of a wide experience in events regarding national healthcare system.
          As for doctors I am quite satisfied with south ward doctors. I had my uncle (brother of my father) saved from diabetes coma, as ward doctor in Loreto Mare Hospital (too much often credited being a bad hospital in Naples) immediately recognized symptoms even before blood sample analyisis was ready.
          Years after that event he was the only one in the family to go to north in the early ’80s to attend laser-therapy in Milan for his eyes retina being damaged by diabetes, and yes, Milan got these laser therapy machines before other cities in Italy as NHS keeps really an eye on north of Italy before than the rest of peninsula.
          His sister (one of my aunts) survived 16 years multiple cancer issues and sustained two interventions in these years, before she died in 2006. I am sure grateful to those doctors who gave her so long life expectancy despite of gravity of her disease.
          My mother survived colon cancer (but to be honest she preferred to sustain private intervention in clinic rather than hospital). As she got colon-stomy, furniture of colon pockets was provided by Italy NHS.
          My father had two hearth bypassing intervention at 73, in 2012, and he is perfectly fine. Costs of intervention were again covered by NHS as it happens for any life-care-save therapies.
          And for all who want to know about how good is healthcare in Italy I must again testimony I had minor brain stroke in 2013 and doctors they made me a T.A.C. X-Ray scan in the very first 30 minutes I entered emergency ward of Hospital Cardarelli in Naples.
          I had to pass 4 out of 7 days on a emergency bed instead of real hospital bed as for lack of budget in Campania causes so disfunction issues in health service, but I received all the care I need together with eco-doppler analisys scan of blood vessels 2nd day and NMR brain scan 4th day, and all were free of any charge thanks to italian healthcare system.



          • Raffaele, thanks for sharing your story and confirming what I’ve always believed, but had no first hand experience with. Yes, the facilities aren’t always the best (depending on where you are), but the level of care is excellent, as is the knowledge and training of the medical staff.

            I’m sure I don’t have to tell you that your outcome would not have been so good in the US unless you were wealthy or had very good insurance through your employer.

            And thanks for recognizing my sense of humor. 🙂

            • Again I want to make another comment in order to advice all those who believe that in US you get no cures at all, or you must stay lying on the soil in case of incidents, if you have no cash.
              So here comes a little remind:

              As long as I know of USA when you entered any hospital (even private ones) if they have an emergency ward open to public (pronto soccorso) they are obliged to rescue you free of any charge and get first aid immediately, including life save interventions. Once saved and got stabilized any subsequent health care therapies are directly charged to your insurance company, if you have any, or directly at your pockets if you have none, or perhaps if your job contract does not include an insurance in its facilities.

              [Not to mention all those unfortunate situations in which insurance companies refuses to pay your cures, claiming your disease is not one of those included in the contract, or claiming your diseases were caused by your wrong life style or because you were not cautious in incidents.
              It is rare occurrencies but exist too, and these unfortunate situations lead necessarily for the ill people to go to court trials paying other fees to lawyers too, along with medical care (there is a entire genre of american filmography dedicated to movies with honest lawyers fighting with insurance companies and forcing them to pay money that they due to clients who need to be hospitalized).]

              It is not uncommon to see people with no relevant incomes (or even poor ones) being saved from an health crisis issue and then dismissed from hospitals once analysis discover that they have cronical diseases and they can’t pay for ling time lasting therapies (e.g. if you suffer of high blood pressure disease, and you get an heart stroke, you got cured for the stroke, but you must pay by yourself, all life long, for medicines to keep your pressure under control, and so on. List if cronic diseases is infinite).
              Another example: If you got your legs fractured in a car incident, the ambulance is free, hospitals accept you and make you X-Rays and fix your leg with gypsum, free of any charge, then they will dismiss you (at least seems to me that this very first-aid is granted by law).
              But then, starting from the moment you exit from hospital, it is up to you to pay your doctor for a visit, to pay for further X-Rays check to be sure if broken bones got sealed again.
              You can return to hospital after a month or two, to get gypsum removed free (as it is again granted by law).

              Correct me if I am wrong, Rick, as I am not so accultured about USA as a real american citizen who have sure direct experience of law and common health pratices.

              In any USA state there are often hospitals kept by religious cults (presbiterians, mormons, catholics) that cure patients free of any charge (it is called “pro-bono” services, in english language if I recall it right) until persons can leave the hospital completely sane again. Often people prefer to go to these hospitals, rather than others.

              There also exist state hospitals, and those kept by municipalities (state hospitals, city hospitals) like those provided by New York State, and you can spot that their wards are really crowded as italian emergency ward ones (you can spot an example of state hospitals in movie “The Fisher King”, 1991, by Terry Gilliam, starring Robin Williams and Jeff Bridges, but it is depicted more messy than in the real). But sure all the rest of healthcare system in the US is not cost free, so you must pay for any services and any sort of medical test including blood sample analysis, that is the most common one in Italy as it is provided by NHS and any italian doctors will issue this test for their clients , at least once a year to be sure that there are no major diseases incoming with age.
              Again correct me if I am wrong.
              Obama just desired to extend this minumum level of healthcare to any citizens onto federal control. Unfortunately republicans are afraid that this fact led US of A. states to be more controlled by central federal power (how outragous for american freedom!) issuing a tax for a minimal nation-wide healthcare system that had sneaky transformed country slowly into a communist nation (Sic est!) and sure it had prevented doctors in USA renouncing a certain amount of their rich wages (and believe me… There is sure no any worst un-american sin than to force any professional to loose any little amount of their income to benefit the nation, the masses, and federal system).
              Again correct me if anything not matches real US system or if I made mistakes or omitted any issues.



              • Sorry I made Italy-english mistake due to speaking habits!

                When you read:

                “rest of healthcare”

                It is intended to meaning:

                “remaining of healthcare”

                Thanks for your comprehension.



              • Forza Rick, forza Raffaele. Great comments. Thoughtful. Quite unlike the folks who are religiously indoctrinated to believe that US health care is the best, period, and don’t you dare say anything bad about my mommy. USA, #38. Woohoo.

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