Maneuvering in the Italian Health Care System
Italians health care may not appear as efficient and well managed as other countries, but considering its comprehensiveness, low ‘out of pocket cost’ and overall quality, it probably should get more credit than it does. Even though Italians often complain about the Italian health care system, Italy ranks 2nd in the “World Health Organization ranking of health systems”.
Though undoubtedly turning to a private international health center has many perks; English fluency of the staff, no waiting around for hours and patient-doctor etiquette that may be more familiar to the one you are accustomed to, understanding how to maneuver the national health system may be well worth it and will save you a lot less frustration as a foreigner. All residents in Italy are entitled to access the Italian National Health Care System, Sistema Sanitario Nazionale (SSN). To apply for this service, you must already have a permit of stay (permesso di soggiorno) and Italian residency (residenza).
Step 1: Getting your ASL Card (Tessera Sanitaria)
The first step is to go to your local ASL (Azienda Sanitaria Locale) to present the necessary paperwork. Oftentimes residents of smaller towns will find they will have a shorter wait and easier process than those in larger cities.
Once you have submitted your application, you will be asked to choose from a list of local health care practitioners who will be your reference doctor (dottore/medico di base) or general practitioner. Without any previous reference, it’s hard to know which one to pick. Most people ask their neighbors for advice or just go with the doctor closes to their home.
So now that you have a medico di base, it’s important to understand his/her role.
Don’t expect the same kind of relationship you had with your family doctor back at home. With appointments lined up every 10 minutes, there’s just no room for small talk. Your doctor will see you for general colds and flus, prescribe necessary drugs and mainly write out medical prescriptions or forms (ricette) for you to be able to carry out your medical needs, including seeing other specialists within the SSN.
The hassle of getting a ricetta from your medico di base, will allow you to benefit from paying a ticket (not to be confused with the English meaning) or the established co-pay price set by the SSN for pharmaceuticals or medical visits. In addition, it allows a medical professional to keep track of your overall health situation with a centralized database.
Your medico di base may have over 1,000 patients assigned to them by ASL and he/she will most likely not know you by name. Fortunately, for the health care system, not everyone has the same level of medical needs and some will never even meet their doctor. This happens when you are healthy without with very little need for medical attention, or when you use their mailbox (la casella) for submitting your requests.
Generally doctors will have a casella located outside of their doors within the waiting area of their medical office. (This is not the same mailbox where the Italian postal system delivers mail.) In most cases, this is a very time efficient way of getting needed ricette for medical exams and medication that has already been prescribed by another medical specialists. For example, if your cardiologist asks for a ECG or your allergists prescribes medication, you should be able to drop this request in without having to wait around for an appointment in person.
Choose your doctor online
As of March 2020, the Health Ministry has opened up the possibility to get prescriptions directly via the Electronic Health Record, app, e-mail, sms or telephone communication. If you are living in Lombardy you can access the website of the Electronic Health Record and digital welfare services of the Lombardy Region: https://www.fascicolosanitario.regione.lombardia.it.
Choose your doctor at a pharmacy
From Tuesday, July 5,2022 residents and health card holders in Lombardy, Italy will be able to choose or change their family doctor (medico di base) or pediatrician at a pharmacy. Show your proof of residency (carte di identità) and your health card (tessera santiaria).
Step 2: Getting an Appointment
Your doctor will have very specific, seemingly impossible calling/visiting hours, which will be impossible to memorize. Keep the hours jotted down with the telephone number as this will go hand in hand. Note that the hours are set in stone. Trying to set an appointment outside of the established calling hours is just not done. That’s right, you must call during appointed times, usually during a one hour slot in the early morning, to make an appointment for the same day. Most doctors will not set appointments for the next day unless you request a private visit.
Tips on Making an Appointment:
- Set an alarm and start dialing your doctor’s number one minute before the set calling hours.
- If you are calling from a cell phone, use the automatic call back service if the number is busy.
- Doctors only accept same-day appointments which is why everyone sick that day is calling at the same hour, understand you will rarely get through at the first try.
So you didn’t get an appointment or you want to see your doctor during the walk-in-day without an appointment (senza appuntamento). I realize writing a section on what to expect during a walk-in appointment was not necessary but thought it was quite humorous. I think most medico di base offices now-a-days are equipped with a numbering system, similar to the butcher section of the supermarket. Once you have let yourself in, be sure to take one of these numbers. There is no welcome reception desk to keep track of whose turn it will be next. In the past, before the diffusion of the numbering machine, patients would ask “Chi è l’ultimo?” (who is the last one?) in order to keep track of when your turn was. You will notice that oftentimes, even with your number at hand, you will still be asked, “Chi è l’ultimo?” It defeats the purpose of the more efficient numbering machine but old traditions are hard to break. And it opens the door to interact with other patients.
Lastly, if you do not like your doctor or find their operating hours impossible, you can go back to ASL at anytime and request a new doctor. Visiting your medico di base is paid for by the national health care system, therefore there is no out of pocket pay unless you request a certificate of health to play sports or other types of certificates for personal use.
Set 3: Going to the Hospital or a Specialized Doctor’s Visit
Having an ASL card entitles you to use the Italian Health care system and its network of public hospitals throughout Italy. In fact, most specialized visits take place in the ambulatorio, rooms dedicated to visiting outpatients, at the hospital. Some private clinics are convenzionata which means they have an agreement with the Italian heath care system to visit patients publicly. The advantage of using these smaller structures are they offer appointments with much less waiting time. For example an eye exam will have a waiting period of one year at some hospitals compare to a few weeks at clinics that are convenzionata. Do your research or better yet, ask a local for advice on where to go. Most major hospitals now have websites where you can submit appointment requests online.
On the day of your appointment, factor in the waiting time; the larger the structure, the longer the waiting time. You should show up to your appointment at least 30 min to one hour before the scheduled time. This will give you enough time for the accetazione. Find the area, Centro Unico Prenotazione (CUP) or the accetazione generale, to pay for your ticket. Prices will range depending on the type of specialist you are seeing. In some case your visit may be free, but you will still be required to go through this long check in process. Don’t be discourage if there are 75 people in line ahead of you, just plan accordingly, arrive early and bring a book (or a novel).
Lastly here are some useful phrases:
I am sick. Sono malato/a.
I have a cold / cough / fever / the flu. Ho il raffreddore/la tosse/la febbre/l’influenza.
I need antibiotics. Ho bisogno di antibiotici.
How often do I take these? Ogni quanto li prendo?
I feel pain here. Sento male qui.
I have a stomach / headache. Ho mal di pancia/testa.
Can I have an appointment for today? Do you have anything earlier / later? Posso avere un appuntamento per oggi? Avreste qualcosa prima/dopo?
Can I have a ricetta to see an… Posso avere una ricetta per vedere un…
Article Easy Milano staff
Easy Milano is the online publication for the international community of Milan. We offer practical tips, key information and essential insights about living and working in Italy. Easy Milano has been assisting English speaking expats in Milan since 1999.
Follow us on Facebook - Instagram - Newsletter