Perche

I had an interesting exchange yesterday that pertains to the quality of health care in Italy vs. the USA. I'm semi-retired, but I still do work that involves international travel. You have to certify your health status to travel to certain places.

I had this exchange yesterday.

Them: "It would be wonderful if you could get a CT scan so we can get the results prior to 9/27."

My response: "I don’t even have a doctor to order the scan."

Them: "Can you go get a doctor tomorrow?"

My response: "Impossible. There are few doctors in Marin who accept California State Cobra insurance. The last time I tried I spent two days on it, and couldn't find anyone who did. When I finally did find someone who accepts CA insurance, like most primary care doctors, they say they are booked full, and not accepting new patients. The ones who are accepting new patients say the next available appointment is in three months. I finally gave up trying to find a doctor. If I were in Italy I could walk into the ER and get a CT scan tonight for $20, but not possible in the USA health care system, that is why it is ranked as the worst health care system in the industrialized world. If you want, I can use my frequent flier miles and go to Venice and get the scan over the weekend and be back by Monday."

PWMTrav

You might opt to do that anyway even if your insurance is accepted. It really depends on what your deductible and copay structure looks like. From my nearest gateway (BOS), Italy is often $400 round trip. Add the weekend at a decent hotel this time of year and you're still home for a thousand bucks, including the CT and the 2-3 great meals you had.

That assumes semi-retired means you have the travel time, but that might be the most fun CT you ever get

For laughs, I just pulled up my SPD to check. Outpatient CT is covered at 80% (assume in-network) after my individual deductible ($500, of which I've spent $100 this year because I'm reasonably healthy). Right off the top, I'm in for $400 of my remaining deductible, $20 for the office visit to my PCP who will refer me, plus 20% of the cost of a CT. Add $40 if the PCP brings in a specialist to refer it. That's going to be $500 all together, at least. And by the way, I have "great" insurance mostly paid by my employer for this privilege. Man, I'd rather double that and get a nice glass of wine and a meal with my CT!

Perche

Hah, hah. If I do find someone who accepts my insurance it's a $1,500 deductible and a 20% co-pay. Given the cost of a doctors office visit, a CT scan, and the radiologist's bill to read the scan, then going back to the doctor's office to get the result, I could probably fly to Italy in business class and get the CT scan done there for less!

PWMTrav

So when are you going? I think I've convinced myself that my next scheduled diagnostic is happening over there.

Perche

Well, it has to be an emergency, not a scheduled doctors visit. If you have chest pain, belly pain, and go to the ER and they do a CT scan, it will cost you about $20. You can't go for an annual physical, but anything emergent, you can do. I had a CT scan that showed a pulmonary embolus a while back. Maybe from too much flying. It led to chest pain that hasn't gone away, and a follow-up scan in a few months was recommended. If I walk into an ER in San Francisco and say I had a pulmonary embolus in the past, and I still have some chest pain, I'd get a bill for the ER visit, the scan, the radiologist, the ER doctor, etc., which would probably cost $6,000 even if they don't find anything. After insurance, I'd still have to pay about $2,000. If they find something, then my out of pocket costs go up.

On the other hand, if I fly to Venice and go to Ospedale San Giovani e Paolo and say I had a pulmonary embolus in the past (true), and I'm still having a little chest pain, I'll be in the CT scanner in 30 minutes. If it's negative, they'll give me a little ticket and go to a machine that looks like a cross between a parking meter and a vending machine. You put the ticket in, and the machine tells you how many euros to put in the slot, or to swipe your credit card. The maximum charge is 20 euros. It's as easy as going to by take out food.

If it's positive and they hospitalize me for a year, when they discharge me I'll get the same ticket, be directed to the same machine, and it will ask me for the same 20 euros. It's a completely different system.

If you want to get elective medical care, rather than emergency, then you have to establish your residency there. A passport is not enough. But emergency care is always free, no matter how extensive the problem is, and not matter how long it takes to fit it, and the outcome results are far better than most countries, including the USA.

estnet

Wow - a PE (pulmonary embolus) certainly is no joke - even with our lousy system in the US sure hope you have good f/u care (like blood thinners if appropriate) esp if you fly a lot!

tkelvin69

Can you pay out of pocket for elective care or do you have to be a resident? I'm traveling around the world for a year or two and will be in Italy when it is time to renew some prescriptions and get a couple lab tests.

Perche

You can certainly pay out of pocket. There are a lot of private practitioner doctors. Many doctors work within the health care system for 20 years, then retire with something like 80% salary for life, then open up an even more lucrative practice. Medications in Italy are not cheap if not within the health care system, so perhaps your USA health care company can give you a, "Travel Waiver" and give you extra medications for the trip. I do it all the time. It might work. Otherwise, there plenty of private practice doctors in Italy, and most speak english.

GoldenItalianBoy

In fact Italy has one of the best health system in the world, I had to say that (-:

JMN57

Well back in Italy for a couple of weeks to get some contractors working on stuff for our house. My poor wife is having terrible luck.

1) Last week she had an acute cystitis attack
2) went to see a MD at the local clinic - her prescribed Cipro and said check back in 3 days - didn't charge us
3) in 3 days, he saw my wife, it hadn't gotten significantly better so he sent her to the Pronto Soccorso (ER) for a sonogram - no charge
4) ER checked her in - did the sonogram - did a CT Scan - only glitch was they wouldn't due with contrast as they were worried about an allergic reaction - gave her the protocol of meds for contrast prep and sent her home (Friday) with an appointment Monday - billed €280 but at the cashiers they reduced it to €211
5) wife in severe pain Friday night - ack to ER at 4AM - they gave her morphine drip, stabilized her and the gave her a pain shot before discharging her - didn't charge us
6) back Monday for a CT with contrast went well - charged €80 - good friend who is a top radiologist in Amsterdam looked at the CT Scan and said it was well done - finding was a kidney stone
7) today - my poor wife had a electric hot water sack burst on her and scalding her in the evening. all farmacia closed - went to Pronto Soccorso (she's now customer #1 ) and they treated her - bill €32


We're heading to Versilia for a consult on the kidney stone with the top urologist in the region - it's Libera Professione so it'll probably cost more but I'm sure all of this would have cost a lot more in the US. I hope for my poor wife that we get this resolved so we can get on a plane back to the States soon.

obscure2k

Wishing all best wishes and a quick recovery for your wife. Please give us an update.

JBD

JMN57 I'm so sorry to read about the horrible physical pain that your wife has confronted, and no doubt you've both been suffering serious mental anguish over all of this.
May your wife have the speediest of recoveries and may this whole chapter be in your rear view soon!

tkelvin69

Thanks. I don't have health care insurance as I'm traveling the world for a couple years and already took almost a years supply which will be done soon. I can't imagine medications being more expensive than big Pharma in the U.S. but I'll check online. Do you think that a private doc in Italy would be willing to prescribe a years worth of medications for a chronic disease like diabetes? I'll be in Europe for 3 months so maybe a different county might be better.

JMN57

Thanks all for the best wishes. My wife's luck hasn't been great. She's got great spirit - laughed at it and said it could have been worse.

Trip to the specialist was delayed (we went, found out we were told the wrong day). Back tomorrow evening. Have to pull the plug on a flight back to PHL on Friday. Silver lining is it may save us a trip back next month as we can finish picking the materials for our kitchen & bathrooms.

Perche

1.Cystitis is not a kidney stone. Different things. Might not be easy to tell the two apart, unless there was back/flank pain.
2. That's what anyone would do, unless there was pain in the back or flank.
3. Sonogram is the next step,
4. CT without contrast, mistake, unless she is diabetic and had signs of kidney failure. Otherwise, you could not see a stone. Perhaps they were just trying to make sure it wasn't something else. Without the details, cannot say. If she is diabetic and/or had an elevated creatinine (sign of early kidney trouble), then what they did was correct.
5. Women who have had a baby, and who also later had a kidney stone, generally say that the pain from a kidney stone was worse.
6. All you can do is wait on a kidney stone, except in rare circumstances. If the test doesn't change the treatment, it wasn't beneficial.
7.?

I'll bet that in Versilia they are going to tell you to wait it out, unless she has a fever. Wishing the best, and believe me, the care wouldn't have been any better back in the USA.