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HEALTH

How bad is Italy’s north-south ‘healthcare gap’ really?

Despite recent improvements, stark regional differences in healthcare provision persist in Italy and the problem seems to be here to stay, writes Silvia Marchetti.

Published: 9 December 2022 16:31 CET
How bad is Italy’s north-south ‘healthcare gap’ really?
The hospital in Locri, in Italy’s southern Calabria region, which regularly sent patients elsewhere due to a lack of doctors and equipment even before the pandemic. (Photo by Gianluca Chininea / AFP)

Italians have a sad saying: ‘health is a right in the north, and a hope in the south’. 

Despite recent improvements, regional differences in healthcare standards continue to plague the country, telling a ‘tale of two Italies’ with the country divided in half, and featuring a trend of southerners travelling north for treatment.

The south-north healthcare gap of the past has of course significantly shortened. Things are very different now from the days when Turin doctor Carlo Levi wrote ‘Cristo si è fermato ad Eboli’ (Christ stopped at Eboli) in 1945, when he talked about the shock of seeing poor children in Matera, the capital of Basilicata, with flies in their eyes and infections. 

Today, Basilicata leads southern regions on healthcare performance. And there are significant differences in standards between southern regions, with Calabria and Molise lagging behind Sicily, Puglia and Campania for treatment and services.

READ ALSO: Five essential facts about Italy’s public healthcare system  

But differences remain, and the pandemic has worsened the outlook according to a recent report by the government’s CNEL agency.

Public healthcare expenditure is at a national average of 1,838 euros per person per year. But the figure is much higher in northern regions than in the south: for example, it’s 2,255 euros in Bolzano versus 1,725 euros in Calabria. 

This translates into lower investments in healthcare in the south, ranging from research in medicines and therapies to top doctors and avant-garde treatments. 

The Policlinico A. Gemelli Hospital in Rome. Italy’s capital is home to several highly-rated hospitals and clinics, but some residents still travel north in search of better or faster treatment. (Photo by Filippo MONTEFORTE / AFP)

Waiting lists in the public healthcare system for checks and surgeries are longer in the south than in the north, where all the best doctors tend to be. I’ve met many southern doctors who, after studying abroad, ditched their native regions for Rome or Milan where most of the top-rated clinics and hospitals are located.

Lombardy, Piedmont and Emilia Romagna have always shone when compared to Sicily and Calabria. And even Rome, despite being the capital, lags behind Milan.

However there have been a few improvements in southern standards lately, and the situation varies depending on the type of treatment.

According to the 2021 public hospitals performance report (PNE), even though the north is showing better results in terms of treatments for cancer and orthopaedics, the poorer southern regions are raising standards in some areas.

For instance, among the top 10 facilities with higher proportions of primary angioplasty guaranteed within 90 minutes, a good index of appropriateness and timeliness, seven are based in the south.

READ ALSO: Who can register for national healthcare in Italy?

Still, the gap has led to a type of ‘health tourism’ within Italy. There are no statistics, but I’ve met many southern people who have had to fly to the north for particular treatments, access to top doctors and cutting-edge surgeries, for example for knee and hip replacements. 

They rented apartments or stayed at hotels for weeks after their surgery to undergo rehab and physiotherapy, at considerable extra expense. 

I’ve met others who had to fly from Salerno and Puglia to Millan and Bologna for hip, shoulder and knee joint reconstruction or replacement, with all the hassle of the journey in poor health and the extra transport and accommodation costs it entails. 

It was striking to find that many Romans are among those who regularly travel to Milan for heart and orthopaedic checks and surgeries. Rome does have a few top-rated clinics, but apparently not as many as Milan.

Meanwhile many doctors from Milan, Padua and Bologna come ‘fishing’ for desperate patients in Rome and Naples who have failed to find a surgeon willing to operate on them due to their complex conditions. 

READ ALSO: The parts of Italy with the best (and worst) quality of life in 2022

This healthcare gap in my view will never completely disappear, despite the incoming European funds through the pandemic recovery plan aimed at shortening it.

It will be further reduced in time, but not in the near future, particularly if all the good doctors continue to flee north for higher salaries, prestige and a more promising career.

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LEARNING ITALIAN

The key Italian vocabulary you’ll need for a doctor’s visit

Seeing a doctor can be a challenging experience if you’re new to the Italian healthcare system, but possibly even more so if your 'dottore' doesn't have a good command of English.

Published: 17 April 2024 12:16 CEST
The key Italian vocabulary you’ll need for a doctor’s visit

Seeing a doctor is usually seen as a fairly uncomplicated task but everything gets a little harder when you’re in a new country, and Italy is really no exception as its healthcare system can be fairly tricky to navigate at first.

Additionally, not all Italian doctors are competent and confident English speakers, which means that their vocabulary may not be enough to cover the full extent of medical terms and procedures involved in an ordinary visit and they may naturally switch to talking to you in their native tongue when asking questions or providing information. 

As such, having some handy vocabulary under your belt can be a big help when trying to bridge any language gaps during your first appointments.

Making an appointment

In order to get an appointment (visita) with a public general practitioner (medico di base), you must be registered with the Italian national healthcare system (Servizio Sanitario Nazionale, or SSN) and hold an Italian health card (tessera sanitaria).

READ ALSO: Italian healthcare: Should you switch from public to private insurance?

Further, while in some countries you may call the local clinic (ambulatorio) and book an appointment with any doctor on duty, that is not how things usually work in Italy.

In order to see an Italian GP, you must be under the care of that particular doctor. Info on how to register with one of the professionals operating in the area covered by your local health authority (Azienda Sanitaria Locale, ASL) can be found here.

Doctor speaking on the phone

A doctor speaks on the phone while inside his office. Photo by Nicolas TUCAT / AFP

Once you’ve registered with a GP, you can go ahead and book your first appointment. You can generally do so via phone, email or, in some cases, online.

When booking by email or phone, you may be given an overview of the doctor’s office hours (orari di apertura) and asked what day (giorno) and time (ora) you’d like to schedule the appointment (fissare la visita). Should you need to reschedule the appointment later on, you could ask: Sarebbe possibile spostare la visita?

Remember: if you’re in need of an urgent appointment, you can ask to see a doctor from Italy’s Guardia Medica, a medical care centre that operates outside of GPs’ normal working hours and on weekends, or visit your local hospital’s ER (pronto soccorso).

Seeing your doctor

Though they provide patients with a set appointment time, Italian clinics tend to run a little late, so you may have to wait for your turn in the waiting room (sala d’attesa).

Also, new patients are usually handed a form (modulo) to fill out with general information about themselves and their overall health (stato di salute) just before their first appointment. 

Once you’re in their office (ufficio), your doctor (dottore for a man and dottoressa for a woman) will enquire about the reasons behind your visit. 

If you’re there for a routine checkup, you could say that you’re visiting for a simple controllo. But if you’re there for any type of health problem, you’ll likely be asked what your symptoms (sintomi) are. 

You may have fairly common symptoms – for instance, a cough (tosse), a sore throat (mal di gola), fever (febbre) or headache (mal di testa).

READ ALSO: Coughs, colds and flu: What to say and do if you fall sick in Italy

But if you don’t really know what you have or don’t exactly know how to describe it in Italian, don’t worry: you can just indicate where the pain is coming from by saying mi fa male followed by the part of your body that’s aching (stomach, or stomaco, abdomen, or addome, chest, or petto, etc.).

Doctor speaking with patient inside his office

A doctor speaks with one of his patients inside his office. Photo by PASCAL POCHARD-CASABIANCA / AFP

At this point, your doctor may ask you further questions on the type of pain you’re feeling – for instance, whether you have a throbbing (pulsante) or stabbing (lancinante) pain – and ask you to lie down (stendersi) or sit (sedersi) on their table (lettino) to perform a physical examination. 

Among other things, the doctor might measure your heart rate (battito cardiaco) and blood pressure (pressione sanguigna), look in your throat or ears with a torch, or listen to your heart or lungs with a stethoscope (stetoscopio).

Further tests and medicines

Depending on the outcome of the physical examination, your doctor may refer you to a specialist for further diagnostic exams and tests (esami diagnostici), including blood tests (esami del sangue), an MRI scan (risonanza magnetica), an ultrasound (ecografia) or an ECG (elettrocardiogramma). 

But if the source and nature of your health problem is already clear to your doctor, you’ll likely be given a prescription (ricetta) for the purchase of medicines (medicine) as well as some instructions to follow to achieve full recovery (completa guarigione).

READ ALSO: Why are medicines so expensive in Italy?

Medicines may come in the form of powder (in polvere), tablets (pastiglie or compresse), drops (gocce) or syrup (sciroppo).

Remember: Italian doctors tend to have fairly bad handwriting (locals often jokingly refer to it as ‘hieroglyphs’), so make sure you know exactly what you need to get at the pharmacy (farmacia) as well as how many times a day (volte) you need to take each medicine. 

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