Health System in Italy

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Health system in Italy

Despite a so-so reputation and considerable prejudice even on the part of many Italians, Italy is in fact a country where you can expect to find low-cost health care and a good standard of medical assistance. Italian doctors are dedicated and well-trained, and the best private hospitals are the equal of any country. State hospitals, however, particularly in the south of Italy, are very patchy, with "creature comforts" be well below what Americans and northern Europeans may take for granted. To avoid this, many foreigners (and Italians) choose to take out private health insurance to cover the costs of hospitalisation and surgery and to get extra comfort when needed, and above all to avoid the long waiting lists that are customary in the state system.


National Health
Italy's national health system (Servizio Sanitario Nazionale or SSN, for short) is administered through local health authorities and provides low or no-cost health care to all EU citizens, including in-patient treatment (including tests, medication and surgery during hospitalisation), visits to family doctors and medical assistance provided by paediatricians, obstetricians and other specialists. It also pays for part, sometimes all, of the cost of drugs and medicines, out-patient treatment and dental treatment. Emergency health provision is available to all EU and non-EU visitors. Regardless of where you come from, you must have some form of health insurance as soon as you arrive in Italy. A permesso di soggiorno will not be issued without it.


Health insurance - how to get insured
If you are working in Italy, your employer will pay your health insurance for you. All you need to do is go to your nearest local health authority (Azienda Sanit?ELocale or ASL) and register with a doctor with the health convention (detailed info available in our Archives). Once you are registered, you will receive a health number and health card (tessera sanitaria) and all visits to your family doctor will be free. He or she will issue you with any necessary prescriptions and referrals to specialists.


If you are an EU citizen visiting Italy, you can take advantage of reciprocal health agreements. Before arriving, you should apply for a certificate of entitlement to treatment (form E111) at least 3 weeks beforehand. (You should make a photocopy of the form and take it with you). If you need medical treatment, go to the foreigners' office (ufficio straniero) in your nearest local health authority (Azienda Sanit?ELocale or ASL) and exchange it for a booklet covering your temporary stay (normally valid up to 3 months). An E111 is no substitute for full holiday insurance, however, and you should make sure you take out a separate policy. If you are a non-EU citizen visiting Italy, you will need to have private insurance cover. You should go to your local police station (questura) within 8 days of arrival and show a health policy (either Italian or foreign) which is valid for the duration of your entry permit (visto d'ingresso). Note that in Italy you will be required to pay in full for any medical treatment first before making a claim via your insurance company. Self-employed, retired or studying? Provided you have residency in Italy, you have the same rights as an Italian and don't need to take out private insurance. Retirees from EU countries will need form E121, and EU nationals transferred to Italy by an employer in their home country will need forms E101 and E111 (further info available from our Archives). Doctors Once you are registered with a doctor (medico) at your local health authority, you can visit him at his surgery (ambulatorio) during surgery hours. Appointments aren't usually required, with most doctors operating on a first-come-first-served basis, so it's advisable to arrive early. If you need to see a specialist, your doctor will give you a referral (impegnativa) which you must take with you when you go to your appointment. Note that you will usually be required to pay at the cashier (cassa) prior to receiving any treatment. Specialists usually work in hospitals or local health buildings, though some private doctors who have an agreement with the health convention also operate from private consulting rooms. National health provides for visits to many different kinds of specialists (including reduced cost spa treatments), though it's advisable to pay for private dental treatment (further info via our Archives).

Drugs and medicines
If you need prescription drugs or medicines, your family doctor will issue you with a prescription (ricetta) which you can then take to a pharmacy (farmacia). Pharmacies in Italy are small family-run businesses and deal in medically-related items only. Pharmacies have the sign of a green or red cross on a white background and outside normal hours, at least one in every town or city will open late for emergency dispensing of drugs. If you have state health cover, you will qualify for the subsidised charge (known as ticket, if applicable: the government just (2001) abolished them) and pay reduced costs. Otherwise you will need to pay the full cost. If you take prescription drugs on a regular basis, you should ask your doctor in your home country for the generic name of the medicine as brands vary from country to country.


State hospitals (ospedali) in Italy can be depressing places, with inadequate nursing back-up, though basic hospital accommodation can always be relied upon. If you need to be hospitalised, you will need to produce your doctor's referral and, if you qualify for state health cover, it will be free. Rooms usually have between 3 and 6 beds, although single rooms are normally available by paying a daily supplement, and they don't usually have TV and bedside telephones. Some hospitals in Italy offer specialised treatment and, under National Health, you can ask to be treated in a hospital in another city.


In an emergency, you will need to go to your nearest casualty department (Pronto Soccorso) and wait to be treated. If you are unable to do so, call 118 and the appropriate medical service will be sent to you. Note that if your medical problem is not considered an emergency, you will be asked to pay for your treatment.

Private or state cover?
Many Italians and foreigners in Italy opt to take out private health insurance over and above the basic state cover. With private insurance, you are free to choose any doctor or specialist and be treated in private hospitals (cliniche), sometimes avoiding a long wait for a specialist appointment or surgery. In private hospitals, accommodation is similar to 5-star hotel accommodation (rooms are air-conditioned, have en-suite bathrooms and extra beds for relatives) and visiting hours are usually unrestricted. However, the quality of medical care is likely to be the same as in public hospitals (doctors often work for both the state and private system) although they don't necessarily have the most up-to-date medical equipment and may lack vital life-saving equipment in the event of an emergency. Note that treatment in private hospitals in Italy can be very costly. Always check beforehand whether your insurance company covers you for your particular type of treatment. Certain Regional Authorities, including Lombardy, have reached agreements with certain private hospitals allowing national health patients to get treatment at the cost of the SSN. This has shortened the queues at public hospitals, but lengthened them at private ones. Generally, you need regional permission before taking advantage of this possibility. However, a recent court decision laid down that patients whose life is endangered by excessive delays in the availability of state health care can go privately, even without prior permission from the Region, and charge the cost to the SSN.


Other services
Services of a medical auxiliary e.g. nurse, chiropodist or physiotherapist are available through a referral from your family practitioner but, depending on where you live, you may have to pay for home visits by nurses. Free counselling for family and relationship problems, which includes pre- and ante-natal care, is also available through a network of local health centres (consultorio familiare), where appointments can usually be made without the need for a doctor's referral

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