‘How I ended up in hospital in Italy – without health insurance’

'How I ended up in hospital in Italy – without health insurance'
Navigating the Italian healthcare system can be daunting, especially in an emergency. Photo: Filippo Monteforte/AFP
Having a medical emergency in Italy before you've got to grips with the healthcare system is many foreigners' nightmare. Mark Hinshaw, an American resident in Le Marche, explains what happened when he found himself in an Italian emergency room – without health insurance.

The boy asked me: “Why is your face red? Did you run here?”

I had just arrived at his parent’s house to join them and some mutual friends for tea. Their house is a ten-minute walk from ours along a flat street and then up a short, steep winding lane. I walked very slowly, stopping several times, as I felt winded.

I had been short of breath for weeks. I had trouble breathing at night. As soon as I lay down, my breath immediately became laboured. I had a disconcerting wheeze. I felt tired and listless. All bad signs; all I had ignored. I blamed it on the unseasonably hot weather in July.

We had lived here for two years. We had private health insurance for our first year, as required by our elective residency visa, but not in the second. And for a variety of reasons, we were not yet signed up for the national health programme. 

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We knew we were taking some risk, but neither my wife nor I had ever needed to see a doctor. For basic aches and pains, we relied upon our local farmacia, with its affable and helpful owner. Although we knew the comune offered a free, open clinic several days each week, we never went. We simply were never sick.

Ignorance plus ignoring obvious symptoms is not a good combination.

Given the boy’s pointed question, I decided to go to the free clinic the next morning. After all, it was merely a hundred metres from our front door. I waited with a half dozen other people, most of whom we knew as other residents.

The dottoressa took my blood pressure and heart rate. Both were significantly elevated. She said I needed to go to the hospital, which was 30 minutes away. Could we get there on our own, or would she need to call an ambulance? This was sounding pretty serious.

She explained that emergency services were free and this was clearly an emergency; I needed care immediately. She wrote a note on her stationary, explaining that.

My wife drove us quickly but cautiously. By the time we arrived, I barely had the energy to walk to the Urgent Care door.

READ ALSO: Emergency in Italy: Who to call and what to say


A hospital emergency entrance in Venice. Photo: DepositPhotos

The doctor’s note got us past reception within minutes. I sat down for an EKG, which showed an erratic heartbeat. I was placed on a gurney to wait my turn for treatment. Every so often a nurse would come by to check on my status.

It was dawning on me that this whole thing was a lot more life-threatening than I thought.

Indeed, after a series of exams, including a sonogram, I was given a diagnosis. For months, it seemed, my lungs had been gradually filling with fluid, eventually to the point of my not being able to breathe easily. The increase had been gradual enough for me to accommodate to it, but it had finally reached a critical point. And because my heart had to do much more work in pumping, it was now enlarged. I could easily have had heart failure at any moment.

Within a matter of hours, a small team of doctors and nurses had drained much of the fluid and put me on a regimen of medications, lots of sleep, and no physical exertion.

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I was impressed with the state-of-the-art equipment at their disposal, despite it not being a huge urban hospital. Moreover, every member of staff was attentive, caring, and reassuring.

All my previous fears and misconceptions of receiving medical treatment in a different country disappeared. Though there were some surprises: Americans are used to a lot more privacy in medical attention than here. Other people were treated in the same room I was in, although with a fabric screen in between.

At one point the nurse asked me for a urine sample. Immediately I looked around for a restroom. Seeing none, I asked: “Bagno?” She said: “Qui!” Alrighty then.   

My wife speaks Italian pretty well, so she worked as my translator. The intake person spoke some English, so there wasn't any difficulty there. The medical staff spoke mostly Italian and my wife's skills were important then, as there was some technical stuff. I was by myself for some of the time, however, and I managed OK with my beginner-level Italian. 


The San Raffaele hospital in Milan. Photo: Miguel Medina/AFP

As my awareness of my surroundings became sharper, I realized another thing that was quite different from my experience in the US. The physical plan – the halls, lobbies, entrance, rooms, waiting areas – were all very plain. In US hospitals, there is often an attempt to make it seem like you are staying in a resort: elegant furnishings and flooring. Dramatic lighting. High ceilings with skylights. Landscaped courtyards.

None of that is necessarily bad, but all of it is obviously expensive. Five years ago I needed emergency treatment to remove my gall bladder while on a trip to Boston. It involved five days in the hospital before they would let me fly home. Even though I was covered by Medicare at the time, I saw the invoice. It was for $140,000!

In Italy, meanwhile, my visit to the emergency room was free. At one point a person with a clipboard came into the treatment room and I figured she was doing an insurance check. The doctor shooed her off, saying it was clearly an emergency. We never spoke to anyone else.

Here, it seems, the money is being spent on the technology, not the trimmings.

READ ALSO: What can Italy teach the rest of the world about health?

In the end, it was the former and not the latter that made the difference to me. The service was as professional and as expeditious as any in my experience. They even offered to have me stay for ten days so they could observe me and provide continuous care. After my wife assured them that she would give me the regular medications and keep me from over-exerting myself, they discharged me. They also said I could come back if things got worse.

Instead I did follow-up care with a private cardiologist. The first exam cost €140, the second was €40 – out of pocket. And I will likely need an angiogram in January.

The treatment in the hospital and the follow-up care over the past four months has me almost back to my normal self. I am breathing fine and my heart is steadily improving.

All in all, my experience with the Italian medical system has been a good one.

Before now two things had stopped us signing up to Italy's Servizio Sanitario Nazionale, or national healthcare plan: when we first talked to the hospital in September 2018 about enrolling, we learned that the rates for retired non-EU residents were significantly higher than we expected. Our British neighbours told us they pay around €400 per year. In fact, we were told that in our case it would be €1,900. 

And you pay in one lump sum for the calendar year, with no pro-rating – so it costs the same for 12 months of health care as it does for one. We didn't want to pay that for just four months, so we continued in the “risk” condition.

But after this? We will sign up next month and pay the full amount.

Useful vocabulary

ambulatorio – clinic, usually drop-in and free to all

Servizio Sanitario Nazionale (SSN) – National Health Service

Azienda sanitaria locale (ASL) – local health authority, where you can register with the National Health Service

tessera sanitaria – national health insurance card, required to benefit from subsidized access to Italy's public health service 

assicurazione sanitaria – private health insurance

medico di base – primary care physician or GP

pronto soccorso – emergency care


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