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HEALTH

OPINION: Why Italy’s private healthcare isn’t always worth the cost

Private healthcare is a popular option in Italy for patients who hope to be seen quickly and receive a high standard of care. But the service may not meet expectations, warns Silvia Marchetti.

Italy has what I would call the most “democratic” public healthcare system in the world (as defined by the Italian health ministry itself). Everyone has the right to be treated for free, without having to flash a credit card at the hospital entrance.

But when it comes to private healthcare options in Italy – sometimes viewed as preferable due to long wait times in the public sector and other factors – I think there’s big room for improvement.

READ ALSO: Public vs private: What are your healthcare options in Italy?

Talking to friends, relatives and colleagues, in the past few months I’ve made a list of cases that are, at the very least, disquieting.

You often pay a lot for private appointments. A friend of mine paid €600 just to have a neurosurgeon check an x-ray scan of his brain which he had already had done, and say “ok, all good”. The appointment was 10 minutes long.

My cousin had to undergo maxillofacial surgery to remove a bad tooth implant; she ended up in a private clinic in Rome where she was charged €5.000 for the operation (under general anaesthesia) and a one-night stay.

You might also think that, given you’re paying for the libera professione (freelance doctors who also work privately), the waiting list for appointments, exams and surgeries would be shorter than if you went through the servizio sanitario publico (state healthcare).

Wrong.

I had to wait four months for a simple private orthopaedic appointment; but a friend of mine beat all records. She waited six months for a rheumatologist to check her wrist, and another eight months for an allergy test at one of Rome’s top hospitals (where doctors also practise libera professione alongside their fixed salary paid by the health ministry.)

READ ALSO: Pregnancy in Italy: Should you choose public or private healthcare?

I don’t want to generalise, nor sound like a classist. But what’s the point of paying for private healthcare services if you don’t get any sort of privileged treatment?

Waiting lists in the public sector are months- if not years-long, and in most cases you don’t get to choose the doctor or surgeon. However, it is a free public service, paid for by taxpayers’ money.

If you use private healthcare in Italy, you pay extra money on top of the taxes already paid for the public sector. It’s like paying twice, and getting just a slightly better service – sometimes. Mandatory healthcare and social security contributions already add up to around 35 percent of the typical employee’s monthly salary.

Man entering a hospital in Italy

Italy’s healthcare system is said to be among the best in the world, but stark regional imbalances persist. Photo by Miguel MEDINA / AFP

I don’t mean to say that doctors who operate privately are better or more prepared than the ‘free’ public ones you get at a hospital. Money can’t buy miracles nor healing power, you get what you get. My granny had a saying: ‘il miglior dottore è quello che non sbaglia mai – con te’ (‘the best doctor is the one who always gets it right – with you’).

However, often going private and having high expectations of a return on the money spent just isn’t worth it, and the end results really leave you baffled.

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Unacceptable mistakes are made, even at top-notch Italian clinics and hospitals that pride themselves in being avantgarde research centres in Europe in specific medical sectors. From incorrect medical reports and diagnoses, to personal data being mixed up between different patients, it can be frankly quite scary.

For example, my 65-year-old aunt was examined in November in Rome by the assistant of a top Milan orthopaedic surgeon who said she had severe knee arthritis and “urgently” needed a total knee replacement.

In December she travelled to Milan, was hospitalised for the ‘pre-ricovero‘ to carry out all the necessary exams and x-rays prior to the surgery, and the following morning she was unexpectedly released.

At 7am, when my aunt was all good to go to the operation room, the surgeon (who had never personally seen her as he had sent his bright assistant to Rome instead), informed her that her arthritis wasn’t that bad after all, and that there could be the risk of skin necrosis had he operated.

My aunt went into panic mode but nonetheless had to pay some €2,000 for the one-night hospital stay.

That reputedly excellent surgeon had made a huge mistake: the diagnosis by his assistant was wrong – but it was his responsibility, he should have paid for my aunt’s “unnecessary” hospital stay.

Once back in Rome, my aunt made another desperate grand tour (‘giro delle sette chiese’, as we say) of plastic surgeons to debunk the skin necrosis excuse given by the Milan orthopaedic.

But her odyssey wasn’t yet over: a month later she received her medical report via email from the one-night hospital stay in Milan, and shockingly found the medical report and colonoscopy result of another person.

The medical records office had made a humongous error: breaching patients’ privacy in Italy is supposed to be a very serious matter.

Such things should not happen in private healthcare, and when they do, patients should be able to bring these errors to the attention of state authorities.

But a watchdog overseeing private doctors, hospitals and clinics is currently lacking. There is a medical licensing board, but doctors are only barred from practising if found guilty by a jury at trial, which must be spearheaded by lawyers hired by the plaintiffs.

An internal oversight committee specific to the healthcare system is needed. Until then, how can issues like these be fixed?

Do you agree or disagree with this opinion piece? Please share your experience of Italian private healthcare in the comments section below.

Member comments

  1. I have recently finished treatment for a detached retina: a first operation to re-attach and the second to correct a ‘pucker’ in the macula. Dr Poddi, the Ophthalmic surgeon in charge at Terni has a formidable reputation and his team is friendly and ultra-professional.

    Six years earlier I was again operated on in Terni, this time by Prof Ettore Mearini using the Da Vinci robot machinery…Again, care was first rate. In each case, following initial examinations, waits were relatively short…

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BREXIT

‘In the dark’: Why Brits in Italy are still unable to prove rights to free healthcare

Despite UK and Italian authorities confirming that British residents covered by post-Brexit rules are entitled to healthcare in Italy, many still face "significant problems" in accessing it, the British government has said.

'In the dark': Why Brits in Italy are still unable to prove rights to free healthcare

Cancer patients are among those in need of treatment but unable to access the Italian national health service amid confusion over post-Brexit rules, campaigners say, after clarifications from the UK and Italian governments have so far failed to resolve bureaucratic deadlocks at local authority level.

Since the end of the Brexit transition period in 2021, many British nationals resident in Italy covered by the Withdrawal Agreement (WA) have reported difficulties in proving their right to free healthcare under the Italian public system.

The problem was exacerbated this year after the Italian government in January hiked the minimum annual fee for ‘voluntary’ healthcare registration from €387 to €2,000, which many said they were unable to pay.

The British government in February stepped in to clarify that UK nationals covered by the WA should not be subject to charges for healthcare, and on its Living in Italy website it advised those affected to show their local health authority office (Azienda Sanitaria Locale, or ASL) an official note published by the Italian health ministry on February 15th which sets out their rights (find it here, in Italian.)

WA beneficiaries “can compulsorily enrol (iscrizione obbligatoria) with the Italian National Health System,” states the final section, pointing out that the deal, “in Article 23, provides for equal treatment with domestic nationals.”

But for some local health officials, even this written confirmation does not appear to be enough to clear up the confusion.

READ ALSO: ‘Life or death situation’: Brits facing high Italian healthcare costs amid rule change uncertainty

The UK government on Friday, May 17th, updated its guidance to say it had become aware that “some beneficiaries of the Withdrawal Agreement are facing significant problems accessing health services and renewing their healthcare cards,” despite its advice to show local health authorities the official note.

British nationals continue to report that local health authorities around Italy remain unwilling to issue them with a health card, while campaigners say the situation is further complicated for some by the fact that Italian authorities have also refused to issue proof of their permanent residency status, which entitles them to free healthcare.

This was the case for Graham Beresford, a British citizen living in Abruzzo who has been diagnosed with a rare cancer and remains unable to access the free healthcare he is entitled to, as he says local authorities don’t understand the post-Brexit rules.

Graham told The Local in April that the government’s clarifications on the issue had made little difference – his ASL continues to demand he pay the 2,000-euro charge.

READ ALSO: Can I get a refund after wrongly paying Italy’s €2,000 healthcare fee?

“Every time I go to my ASL office, I always feel like I’m dismissed,” Graham said. “I told the ASL worker I need medication for my cancer and she replied lots of people come in here with sob stories.

“There genuinely seems to be no compassion whatsoever.”

Graham’s story was reported in The Guardian on May 12th ahead of UK foreign secretary David Cameron’s first major meeting with European commission vice-president Maroš Šefčovič to discuss post-Brexit relations.

Campaigners also wrote to Cameron in April to appeal for help with the “desperate” situation faced by those unable to access care in Italy.

In its update to the Living in Italy website on Friday, the British government stated: “Since [the health ministry’s note] was published, and particularly in recent days and weeks, it has become clear to us that not all Italian authorities are consistently following this guidance.”

“We are urgently speaking to all relevant parts of the Italian government to clarify the situation so that we can give clear advice to those affected as soon as possible. 

“We also know that this problem is linked to the many difficulties some are experiencing with obtaining an attestazione di soggiorno permanente and/or the Carta di Soggiorno permanente. We are working to help with these issues too.

“We will update this page as soon as we have further news.”

READ ALSO: ‘We are desperate’: Why the UK must help Britons with Italian healthcare charges

Clarissa Killwick from Beyond Brexit, a group for UK citizens in Italy, said the situation “should never have been allowed to happen” and that there had been “a series of communication failures and inconsistencies.”

“We’re not far short of five months after the introduction of the €2,000 new minimum for voluntary contributions and there is still no clarity,” she added.

“There are fraught exchanges in public offices because people on both sides of the counter are in the dark or with conflicting information.

“People need information they can rely on, unequivocally. What do you say to someone who is waiting for an operation but has no idea what is going on?”

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