An Insightful Rant By A Scorned Patient. What's Wrong With The Medical System in Abruzzo?

Usually I try to keep my writings positive, but some things just need to be aired. Lets chat about the utter lack in efficiency in some italian public service sectors. I am infuriated by the joke of a medical system here in Abruzzo, ASL. This article is not meant to attack the socialized aspects of the medical system,  which is something I vigorously applaud. But, its rather a look at the logistical nightmare that is medical care in Italy. 

Here, we have a nationalized medical system which is, in theory, inter-connected not just with all of Italy but all of Europe. But each region runs its own medical program starting with each municipality dividing its residents up amongst a list of general practitioner doctors ("GP") in their respective municipalities. Its relatively easy to get in touch with your GP; and like America's HMO's the GP is your gateway doctor. If you want the medical system to cover your test costs - and I use the term cover very loosely - you have to start with your GP and get a paper prescription for a specialist, test, or prescription. Here's where the nightmare begins. When you go to the next step you hit major roadblocks and confusion. For the sake of time and clarity I will list the major issues:

1) You must carry your own medical records from one appointment to the next. They have NO centralized or electronic medical sharing here. NONE!

2) Depending on the urgency, you could wait months or more to get into a simple test appointment.  In September, they wanted to book my appointment for February 2011! And, I have heard worse stories. 

3) Even if you want to stay in the nationalized system, you still have to pay an admission ticket at the hospital every time you do a test or see a specialist. So, in fact you pay twice. First through a boatload of taxes, then again for your individual care. 

4) You pay even more if you want to avoid the confusion and go "private" which basically means you pay a pubic doctor for his private time. 

Now, I will say that their private payments are nothing compared to what a U.S. uninsured person would pay. And, I love the fact that I can pop into virtually any specialist and pay 80 Euro for a consultation. But, I have had to undergo comprehensive allergy testing and it has taken approximately 3 months so far, and I am not done yet. Its always "go to this hospital, do a consult, go to another hospital take 2 test, but then another location and take a blood test on yet a different day." Its not uncommon to get misinformation at one appointment so you are unprepared for the next. There seems to be little to no dialogue between offices or even between the hospitals administration and the practitioners.

During this process that has become not a bad chapter in my week, but a bad chapter in my year because it takes so long, I have had to play russian roulette every time I eat something during this five month long period. And, don't forget I am lugging my records from one place to the next because they don't transfer them internally. I can only imagine what it it takes for someone who is really sick. I will admit that if you have a grave emergency things go on the fast track, but how many people have tumors growing inside them as they wait for stupid little screening tests to be completed before they realize its something more serious. 

For me it almost always comes back to efficiency; what is the damage to the Italian economy for such inefficiencies? When people have jobs, and need to miss work 11 times over 6 months just for testing, there has got to be a large economic cost to their employer in the way of lost productivity. Then, you consider the lost productivity of someone not feeling well during that entire diagnosis period. Even if they are jobless, they are surely not hunting down a job when they are in this long drawn out holding position. And, the same goes for a lot of things. We end up waiting at the post office for 20 minutes only to get useless information at the front of the line and have to return another day. Or, I am constantly told to come back another day at a store or service point because they are too busy or about to close, etc. What is the deal with never wanting to push through and complete a transaction? 

If you want further information on the economic impact of this (please note how totally ecstatic I am that I actually have time to look up stuff like this solely because I want to!) Italy ranks higher than most in GDP per person working, but still lower than the US. They did, however outrank UK and Germany in this respect, which was a personal shock to me. (See pages 35-36 for some country-by-country statistics on GDP and productivity. (http://www.bls.gov/opub/mlr/1999/07/art3full.pdf). or see Eurostat website, an EU agency that tracks European statistics on a country and regional basis. (http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/themes) 

Someone asked me the other day if the experiences I am having are unique to my region, as in maybe I am living in the Italian equivalent to Mississippi, which by all accounts is not the crown jewel of our United States. When I go on the attack, I must remind myself that I am living in one town, in one of twenty regions in a relatively large country of 60 million people. After doing some of the statistical research on Italy, as referenced above, I have to conclude this inefficiency or lack of desire to complete a transaction must be a regional issue and is not the plight of the entire country. The statistics do not lend themselves to a conclusion that Italians as a whole are not productive. 

And, as I am often reminded by those in my Italian family, Italy is a very young republic which explains the difference in the regions and the lack of logistical co-ordination of so-called national services. Italy, as a constitutional republic has only been around since 1946. Before that it was comprised of several nation-states that were unified between 1815-1870, still much later than the United States unification with the original colonies. 

No matter whether this is a regional problem or a national problem, I am demanding change. Italian, like most Europeans, pay a ton of taxes, approximately 50% of their earnings and 20% sales tax. Supposedly, this is to pay for the medical services, schools, and other essential public services. However, we end up paying point-of-service for medical as well. And, according to those I have talked to its not cheap. Tests run anywhere from 100E to 200E, plus patients pay an admission tickets, drug costs, and for specialist visits. It seems a little bit like double taxation since its all going to the government. Same goes for the toll roads or "autostrada" and other supposedly socialized services. And, the schools, while they may provide a great education, are hosted in decrepit outdated buildings which are not up to par with technology or even a designated parking lot.  I am 100% in support of pooling our tax money to provide services, but I must ask where is this money going in our area? Italy is ranked the 18th most developed country in the world, but it seems a long cry from my home in California. 

I am told that in the north things are a lot faster, cleaner, and modernized. Of course, they also have more stress so there is always a trade-off. But, I must admit that I am at the end of my wits the way things move so slowly here. Why can't I sign the inscription form and pay when my daughter starts her first ballet lesson. Why do shop owners repeatedly offer to call when something comes in, and I have yet to receive one call when that happens. Why is it always pushed off for a later time? And, when it comes to something as important as medical care, there is no room to be lazy or disorganized. We must start demanding better and take nothing less. In the end, only the squeaky wheel gets the grease.