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Pregnancy in Italy: What are the options for public or private healthcare?

John Last
John Last - [email protected]
Pregnancy in Italy: What are the options for public or private healthcare?
A midwife monitoring a pregnant woman. (Photo by MYCHELE DANIAU / AFP)

If you’re pregnant in Italy, you’ll need to decide who you want looking after you for the next nine months. Here’s a look at how public and private healthcare options compare.

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Italy is one of the safest countries in the world to give birth, ranking well above the United States, Britain, and Canada on maternal health.

But despite those stats, the health system in Italy can be confusing to first time users — especially when dealing with something as high-stakes as a pregnancy.

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Fortunately, The Local is here to break it down, starting at the beginning: how to choose a doctor to help navigate your pregnancy.

Your first appointment

As soon as you find out you are pregnant, you will want to organize your first appointment with an obstetrician (prima visita ostetrica).

At this appointment, a whole raft of initial tests — blood and urine sampling, a Pap smear test, and a physical evaluation — will be ordered, and your pregnancy will be confirmed by ultrasound. For this reason, official advice says you should try to schedule this appointment no earlier than six weeks and no later than 11 weeks after your last period.

READ ALSO: How to book a doctor's appointment in Italy

The obstetrician will also brief you on the free services available to you during pregnancy, like parenting classes and psychiatric services, and start your cartella della gravidanza (pregnancy folder), where all your information will be kept as it travels from provider to provider.

But before you can even make this appointment, you need to decide whether you’d like to use Italy’s public health care system, or opt for a private provider.

The public healthcare option

In Italy, more or less everything that is medically necessary as part of your pregnancy is covered by the Italian national health service (servizio sanitario nazionale or SSN).

That includes things like monthly check-ups, regular testing, two ultrasounds, and your delivery and postpartum care. Since 2017, it has also included non-invasive screening for common genetic disorders, though accredited public providers may not be available in your region yet — meaning you may need to rely on a private provider to receive these services.

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

Any specialist services deemed necessary for the health of the pregnancy should also be provided free of charge, so long as they are available through the local public system.

You’re entitled to these services even without a health card (tessera sanitaria), so long as you are an EU citizen or have a long-stay residency permit (permesso di soggiorno) and are referred to them by a doctor.

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These services are accessed by making appointments at your local hospital or by referral from your family doctor. They’ll give you a sheet or card with a barcode (called a ricevuta) which will be used when you show up for your appointment. In most cases, at your first visit with the obstetrician, you’ll be scheduled for subsequent follow-ups.

The downside of getting your care at the local hospital is that you will likely be dealing with different staff each time you visit. If you have questions or an emergency, you won’t have a doctor you can text or call, and there can be long waits for certain tests and procedures that may prevent you from receiving them at the right time.

It’s for that reason that, according to Italy's top health institute, the Istituto superiore della sanità or ISS, some 80 percent of first-time mothers choose to use a private provider instead.

Photo by ERIC FEFERBERG / AFP

Private providers

If you choose a private obstetrician, you will likely have just one doctor or a small team who follows you through your whole pregnancy, who will be more easily reachable if you have a quick question or a sudden emergency.

You’ll have more choice about the gender and location of your provider, and they will usually be less overworked, meaning they may spend more time with you during check-ups. You will also be able to select a physician you know speaks English, for example, if your Italian is not strong, and you may receive additional tests or more regular ultrasounds.

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But beware, these services can be very expensive. At the outset, you will likely pay between €100 and €250 for your first appointment. Subsequent visits can cost anywhere between €70 and €200, and many tests that they order will cost you as well, totalling €2,500 or more over the course of a pregnancy.

If you don’t want to give birth in a hospital, some clinics offer private options for the delivery as well — at a cost.

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

You can give birth at home, for instance, or at a private clinic or maternity home set up specifically for delivery. These services can cost €2,000-€3,000 or more, but they do often include amenities like birthing tubs, diapers, and on-call care from midwives.

One common reason people opt for private care is that they hope their obstetrician will be the one to deliver the baby. But that’s reportedly very uncommon in Italy. Unless your timing is just right, it’s more likely that midwives manage the birth — but they’re generally said to be both highly experienced and extremely competent, in private clinics and public hospitals alike.

Finding a private option

If you do decide to go for a private provider, the best way to find one is by word of mouth. That means asking around widely about who people would recommend. Talk to friends, colleagues, and your family doctor, and do what research you can online.

Keep in mind that there is not much love lost between public and private providers — hospital staff are not supposed to refer you to private providers and will sometimes bristle at the request. If they do refer you, they may ask that you keep it quiet as a result.

Once you have some recommendations, it makes sense to briefly check in with each of them to find out what they charge for various services — prices are rarely posted online.

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

It’s also a good idea to make sure whoever you choose is also competent in ultrasound technology (ecografia in Italian) to avoid having to make appointments with dedicated specialists.

Because of the high cost of private clinics, some parents opt to mix appointments in public and private systems, doing their regular check-ups with a dedicated gynecologist, for example, and handling expensive testing via the public system.

If you choose to do this, make sure to keep printed copies of all your documentation, as not all clinics are connected with the public system and may not be able to retrieve test results on your behalf.

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A third option: consultori familiari

If you want the dedicated care of a private practice but balk at the price tag of a few thousand euro, there is a third way.

Born of the women’s movement in the 1970s, Italy also has a growing number of public family counseling centers (consultori familiari in Italian), which provide a broad array of services related to pregnancy and family planning.

These centers maintain a dedicated, multidisciplinary team of obstetricians, pediatricians, social workers and therapists who can follow you through the whole process of pregnancy and arrange for all necessary tests and procedures.

READ ALSO: 15 practical tips for pregnancy in Italy

They will also refer you to courses and classes to prepare for pregnancy and parenthood, and are connected into a wider network of family planning and women’s health service providers. If you decide to terminate your pregnancy, for example, they can provide the necessary documentation to secure a legal abortion.

Though they will not provide the on-call, anytime service of a private provider, these centers provide their services for free. By law, they also must provide assistance to all women and children, regardless of their citizenship or immigration status.

You can find more information about your nearest available consultori familiari on the website of your local health authority.

For more information about healthcare during pregnancy in Italy, see the health ministry's official website here.

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