Perche

Let's stay on topic here and get back to discussing what to do if you get sick in Italy.

Perche

It was pointed out in this thread that according to the World Health Organization, Italy has the second best health care system in the world, after France. Another interesting health metric was just released. It ranked Italy as having the healthiest people in the world, followed by Iceland, Switzerland, Singapore, Australia, Spain, Japan, Sweden, Israel, and Luxembourg, in that order. Among the top 35 the USA was 34th, just ahead of Croatia.

Using data from the World Health Organization, World Bank, and United Nations Population Division, the metrics were, 1. death rate by disease or injury; 2. life expectancy at birth; childhood; adolescence; and at retirement age; 3. probability of a neonate surviving to retirement. 4. Health risks such as rates of hypertension, high blood glucose, high cholesterol, being overweight, tobacco use, excess alcohol consumption, physical inactivity, childhood malnutrition, mental health and vaccines. The Bloomberg School of Public Health is Johns Hopkins School of Public Health, the best in the USA, with Harvard School of Public Health ranked second.

https://www.bloomberg.com/news/artic...lthiest-people

http://www.newsy.com/stories/italy-i...ntry-in-world/ (you have to wait for the video)

https://qz.com/937184/who-are-the-he...-in-the-world/

The most important factor seemed to be Italy's easy access to health care. Italy and the other 4 countries making up the top 5 have universal access to doctors, especially primary care and preventive medicine, and people can obtain medications at no cost or very low cost.

Instead of the USA fast food culture they have a Mediterranean diet and local, fresh food culture. The other factor was thought to be work-life balance. The average salaried American is on the job 47 hours per week, meaning they work an extra day each week, usually without getting paid for it. That rarely happens in Italy. There are deadlines where people work extra, but then they take off to make up for it. It is not expected that you will willingly arrive to the job early and leave late without pay to impress the boss and get a promotion.

The average job in the USA provides ten paid days (two weeks) of vacation per year. In Italy it doesn't matter if you are the most important or least important person at the job: by law you must take 4 weeks of paid vacation per year. By custom, pretty much everyone has agreed to do it in August, which is why everything is closed, except in places like Rome, Florence, and Venice.

An Italian can expect to live many more years of life without sickness than an American because they are much less likely to have stress-related hypertension, and high cholesterol from inactivity and eating a poor diet.

There are a lot of different reasons to visit Italy. I can understand the desire to whiz through a lot of towns for half a day each. There are different travel styles, and no single right or wrong way. For me, I try to experience Italy to make that "healthiest in the world" lifestyle rub off on me.

I knew that Italy offered some of the best health care in the world, but I hadn't yet seen it published as resulting in the healthiest population in the world.

Perche

I know that the medical services in Italy are among the best in the world, and that emergency care is free. I'm less familiar with Italian dental care.

I just had a dental emergency. Bridges and cap are only supposed to last 5-10 years, and mine were over 20 years old, but this is the 3rd trip in a row to Italy where one of them has come off while eating pizza. The pizza here is very different from the USA. It's very chewy. The last two times, a crown came off, and it was no big deal. When I got back to San Francisco I had them replaced with new ones. Last Sunday I was eating a pizza when all of a sudden things go too crunchy, and I thought they might have put a bone in my pizza. My bridge had fallen off. It covered three teeth, which is a lot of territory.

I didn't know if it was serious to have things exposed like that, so I asked the proprietor if he could recommend a dentist. He gave me a flier that I think someone mentioned upthread, of a company that sends doctors to hotels for tourists who get sick. I told him that's ridiculous, I am not paying that. Those services send very amateurish doctors who only give over the counter meds, or occasionally an unnecessary antibiotic, and if it's an emergency just send you to the ER anyway, and charge $150 then the hotel adds on a service fee.

The next day I called a friend who's boyfriend is a dentist. They had just gotten backed from vacation and his office was packed with overbooked patients, and he couldn't squeeze me in. I then bumped into three friends and told them my dilemma, and one said to go to the ER. The other one said that's crazy, most ER's don't have a dentist. The third one fumbled through her purse and pulled out the business card of her dentist, and she called his office, and put me on the phone. Then I received this email:

"questo semplice controllo non costa nulla. Mi hanno detto che se devi ricementare il ponte è semplice ma se è un intervento più complicato te lo dicono, ti fanno un prevenitvo. Immagino che deciderai, poi di farlo negli US. Domani ti spiego meglio una cosa."

"It will not cost anything just to check things out and to cement your bridge back on. If you need complicated dental work, you would be given an estimate before hand. I suspect you will want to wait until you get back to the USA. Tomorrow when you come in I will give you a better explanation."

I went today, and the charge was zero dollars. The dentist was extremely professional, and had more modern equipment than my dentist in CA.

I'm not saying that from this experience that I know that emergency dental, like medical care, is free. However, should an emergency arise, I wouldn't hesitate to use their services. They didn't even bill me, it was all free.

JMN57

FYI - in early July I had to spend the night at Perugia Hospital. I had an intestinal blockage and gas and it was painful and my bp had spiked quite a bit. When they checked me in they took my information for billing purposes. They took x-rays and ultrasound imaged, I got a couple of IV's and they gave me some meds. They fed me breakfast and lunch before discharging me.

I just received a bill for €244. Not free but certainly not out of line for the care I was given. I'm sure that without insurance my bill in the States would have been much larger. I'll just pay this out of my HSA so it's even pre-tax $'s (or €'s if you will).

They took great care of me, let my wife spend the night with me (her Italian is much better than mine and she didn't want to drive 40 km to a top of a mountain where we were staying) and a nice young doctor even scared up a USB charger so my wife and I could keep our phones charged. She was particularly reassuring to my wife who was somewhat distraught.

Perche

That's excellent, because the average bill for a visit to the ER in the USA is $1,233, even if they don't do anything and just send you home. If you had asked that Italian doctor, I'm sure he would have waived the charge, or reduced it to about $20.

The cost of a visit to the ER in the USA even without being admitted to the hospital costs almost the equivalent of two months rent. According to the Wall Street Journal going to the ER in the USA for a headache can cost as much as $17,000, and going to the ER for a urinary tract infraction can cost $70,000, even if they just see you and send you back home. The average price for someone seen in an emergency room in the USA with an intestinal problem who doesn't even get admitted to the hospital is $29,551. I suspect that is why the USA always ranks at the bottom of the list in ratings of health care quality and outcomes in the industrialized world.

For July in Italy 244 euros is about the cost of spending a night in a hotel. Health care in Italy is generally ranked as the best or second best in the world (usually after France), and is one of the reasons why Italians are the healthiest people in the world, just ahead of Iceland, Singapore, Switzerland, and Australia, even though so many Italians smoke, they exercise less than those in any other country in Europe, there is no such thing as low fat food, diet food, decaffeinated coffee, etc., and they eat donuts for breakfast. Their health care system is amazing. The health of the USA's population isn't even in the top 25 in the world. It ranks 34th, although it spends almost three times as much money on health care per capita than any other country.

https://www.washingtonpost.com/news/...=.d05d0f1ee9d9

https://www.bloomberg.com/news/artic...lthiest-people

JMN57

In my personal opinion, I have come to the conclusion that healthcare in the US is monopolistically price-fixed. The book price is always exorbitant and it only gets reduced with an insurance policy which your are essentially blackmailed into taking or suffer the high fixed price. The real kicker is that there is rarely price transparency - one has no idea what anything costs until you get the bill.

As a side story, I was at my doctors office for an annual check-up earlier this year. A 60'ish women came in and there was an issue with her insurance - her husband had changed jobs, etc. She was there for a shot which, from what I overheard, was pretty important for her well being. They told her that without the insurance it would be $3500 - she passed on the shot. Was sad.

So, enough of that before we cross over into OMNI territory.

JMN57

BTW - my first visit was to a local doc in Tavernelle who referred me to the Pronto Soccoso @ Perugia. He noted that he detected a slight heart murmur which, I believe, was merely a ruse to get me bumped to the head of the line. He didn't charge me anything and also called a number of times to check on me while I was in the hospital. He kept my AirBnb host informed and they let me check out later than deadline at no extra charge.

The charge (I believe) was for Pronto Soccorso, tests and the overnight. I think I get billed more for my dental x-rays by my dentist.

ticino

A few weeks ago I had to visit the pronto soccorso in Venice, and really, I couldn't believe my eyes. I just went around the older parts of the hospital where it is located taking pictures because it was so cool!! And peaceful.

What impressed me the most though was the excellent attention. Even though I was assigned to the lowest priority level I got to see a doctor in maybe 20 minutes and was even offered to see a specialist the next day. I only had to pay 29 EUR, with the UE insurance card.

In Sweden they wouldn't allow me to come to the hospital because I didn't have a fever. This was a small cut that I suspected could be infected.

Next time I need to see a doctor I may take a flight to Venice.

slawecki

my wife and i have gotten ill 4 times in venice. (over 20 years). on each occasion, we stay in tiny boutique hotels, we tell management we are sick. they call a friendly local doctor. he comes to our hotel room, and examines us. pills, shots, and advice are provided. the charge is $100 for 2 or 3 visits. we have tried self medication, and going to the local pharmacy and to major hospital in the area.

i strongly recommend to have the hotel desk call the local doctor. they have done it all before.

Perche

I think the local hotel desk is not the way to go. It could be convenient because you don't have to leave your hotel room, but doctors doing hotel service calls are not exactly doctors with thriving, busy practices, and the best credentials.

It is not possible for them to run any diagnostic tests in your hotel room. No blood tests, no EKG, no x-ray, no cultures, basically no modern medicine. They basically come and give some penicillin-like antibiotics even if they haven't obtained a culture to see if you have an infection, they give you something like pepto-bismol if you have diarrhea, and they give you Tylenol, which has a different name in Italy. There is no fancy medical work going on in a hotel room. You pay a few hundred dollars for health care that is free in Italy, then natures takes its course and you recover from what was a self-limiting illness.

If the symptoms are ruining your vacation because you have a cough, running nose, diarrhea, go to a pharmacist where they will give you something to reduce the symptoms.

If you are sick you should go the ER. No, the hotel desk clerk and their retired on-call doctor who travels to the hotel with a bag full of over-the-counter medications, a stethoscope and a shot of antibiotics has not done it all before. No doctor has done it all before. A surgeon who takes out your appendix has never treated a stroke, and a neurologist who treats strokes has never done a coronary angioplasty on someone having a heart attack. And the local hotel doctor might be a retired allergist who treated children.

I don't know how the hotel doc can give you a shot and advice if he doesn't know what you have because he can't even run even the simplest of diagnostic tests in the hotel room.

How can the hotel desk clerk even know what type of doctor to call? Are you having frequently overlooked symptoms of an MI for which delays can be fatal, and you need a cardiologist to do an angioplasty? If you are having early signs of a stroke the hotel clerk can't diagnose that and call a neurologist. If you are having an exacerbation of COPD and need to be on oxygen, will not fit in the hotel's on-call doc's bag.

You should not put your health into the hands of the desk clerk at a boutique hotel. If you are sick, go to the ER where the proper doctors are on the premises, and moreover, the service is free. If you have diarrhea, the flu, or some such thing, that you feel will pass and you just need to feel better, go to the pharmacist.

It may turn out that you don't need a specialist, but that's a decision for the trained, ER triage nurse to make, not the hotel desk clerk. I can guarantee that when the hotel's on call doctor shows up, if they see you are actually sick, the first thing they will do is call 118, the number to call for an ambulance in Italy. Local hotel docs are not going to handle anything more than a cold, diarrhea, or an upset stomach, which the local pharmacist can do.

estnet

Perche - VERY WELL SAID.

For run of the mill stuff it sort of doesn't matter - BUT - when it's something time sensitive being in the right place (the hospital where they can do appropriate diagnostics) can't be beat

KLouis

The "house" doctor can, alternatively, act as the... triage nurse, of course you pay €100 for that, rather than having it free. By the way, you'd been amazed to hear the collection of extremely dangerous and stupid statements I've heard from pharmacists throughout the world over the last decades. If there are people who feel that they know more about medicine than my mother/sister/wife solely because they are daughters/mothers/sisters/wifes of medics (none of them went to Med School), be assured, these are pharmacists.

PWMTrav

In fairness, to an American, $100 for a doctor to come out and triage you seems like a bargain. I have what most would consider excellent health insurance, and setting foot in urgent care costs me $50, the ER $100 (but waived if they admit me!). Without "knowing" how Italy works, most wouldn't think to go to the ER because they assume it's like the US - or even if they know it's different, they don't know what the difference is or that it's more economical.

This thread is valuable in that sense. If you get sick in Italy, go see someone, because you won't go broke doing it.

Perche

The only thing is that with the hotel doctor you wait an hour for them, just to have them send you to Pronto Soccorso (ER) if you are sick. The hotel doctor is not going to be anywhere near as knowledgable as a triage nurse, who is a senior nurse using strict protocols and checklists to identify problems, and has an array of diagnostic tools and consultants available. The hotel doc usually is retired and not in practice, or is a young doctor who shows up driving a motorcycle, carrying a little black bag.

I wouldn't be comfortable that they can differentiate a headache needing aspirin from a headache due to an early evolving stroke, or whether the "indigestion is just something needing Pepto-Bismol, or the first symptom of an inferior wall myocardial infarction, the first sign of which is often nausea. In the ER things like CT scans, EKG's, and lab tests would be taken, and you will be sign by an appropriate specialist, whether it's ENT or gynecology.

Pharmacists in Italy are allowed more leeway in dispensing health advice and selling medications than in the US. If you can describe your condition well, you may be able to get prescription medication directly from a pharmacist in Italy, because have a lot more training that a pharmacist in other places like the USA. Likewise, if you need a prescription filled on an emergency basis, you may be able to get it if you know the name of the medicine and can make a good case for the pharmacist to dispense it..

If you are suffering something more serious, or have had an injury not likely to be helped by aspirin, you should go to the 24-hour pronto soccorso (ER), at any hospital.

Venice and many other cities have something called Guardia Turistica designed especially for tourists. Real ER docs, not whomever the on-call hotel doc is, will take your call and come to your hotel. They are available from June 15 to September 30 from 8:30 to 1:30, and from 2:30 to 7:30. They are not available 24/7 because they are not for true emergencies, for which you should be going to the ER.

If you need symptomatic relief of something, diarrhea, heart burn, etc and wan to go to the farmacia, don't confuse a farmacia with a parafarmacia. That's easy to do if you don't pay attention to the sign. Parafarmacia just sells herbs, roots, homeopathic stuff, and not actual medicine, and doesn't have training in medicine like a parafarmacist.

In the USA if you have some normal ache or pain you go to the pharmacist, and the over the counter medications are on the shelves. You read the label on the box, pick it up, and go to the cash register. That, for the most part, is not how things are done in Italy.

Even the non-prescription medications are behind the counter, and the pharmacist you deal with is going to seem a lot more like a doctor than someone simply working a cash register at Walgreens or CVS. They ask you a bunch of questions before handing you a box of pills. For example, they might be trying to figure out if your stuffy nose is due to allergies or a cold. Or, they might tell you to go to the ER.

KLouis

I read your previous post ver carefully before answering (even in a short form), and the same is true for the last one. I 100% agree with you that the ER of a public hospital is the place to go in cases of medical emergencies, especially in Italy (and several more countries in the EU), where they won't rip you off.

Having said that, I don't want to get involved in a discussion on whether an old/young doctor is better or worse qualified than a triage nurse to diagnose or, in particular, decide what a problem is (not to cttend to it in a hotel room), or whether a pharmacist/parapharmacist does indeed have the necessary training and experience to provide basic health care (other than helping with a bleeding wound). Let's leave it at that.