Another week in Italy to reflect upon!
I continue to be amazed by the caring physicians and healthcare workers here who take pride in their work and in their relationships with colleagues and patients through the most humbling words and deeds. Around town physicians are respected and treated with the utmost integrity - no matter if we are at church, a local pizzeria, our hotel lobby, or simply just walking around town.
The town in which I am staying is called San Giovanni in Fiore. It is located high in the Sila National Forest. Because the town is so small, they do not have the luxury of the specialists and treatments found in the larger cities in the region. They often must refer to specialists and surgeons in other parts of town for escalated care. Both the mountains and access to medical care remind me of my rural health experiences through the WVU School of Medicine.
This week we visited an inpatient service at the hospital in San Giovani in Fiore. Rounds were staffed by internal medicine physicians with records taken on paper charts with lists of vitals, medications, and treatment plans for each patient. Ultrasound machines were brought to the bedside. Imaging exams were performed by the physician with the nursing staff at the bedside. It was quick and efficient. The small hospital had a short hallway that divided the female rooms from the male rooms. Break rooms were fully stocked with supplies for espresso, per usual!
We also traveled to visit the Neonatal Intensive Care Unit (NICU) in the larger city of Cosenza. It looked very similar to the NICU I am familiar with in West Virginia. We interacted with one Neonatologist and a variety of nurses working alongside her. Families were permitted to enter the nursery at their leisure to spend time with their little ones. Newborn babies undergo similar cardiac, audiology, and genetic screenings as in the USA. Italy's screening protocol includes 40 inherited metabolic disorders. The panel varies per region of the country.
One of the most impressive multi-disciplinary clinics that we visited this week was the Women's Health Clinic run by the public health department in San Giovanni in Fiore. It is only open certain days of the week and publicizes its availability to the community. The clinic provides screening tests, prenatal care, behavioral medicine, contraception, and social work consultations in one shared workspace. Similar to the USA, women can attend prenatal and birthing classes. It was amazing that all of these services were offered in a small centrally accessible facility.
This week, we spoke with many physicians about how the health system nationally differs from the USA. It was incredible to appreciate the differences and similarities. I did some additional research on the hierarchy of the national healthcare system in Italy as well as the cost breakdown. I have explained a little below along with some resources I utilized to elaborate and confirm what I learned in conversation.
In Italy, healthcare is a mixture of public and private systems. The national healthcare system has existed since 1978 by Decree 833 which established a tax-funded national health service. The health service is called Servizio Sanitario Nazionale (SSN) and is governed by central, regional, and local sectors. It provides care for all citizens and legal foreign residents. This allows patients to have access to a family physician, preventative care, vaccinations, health services related to social care, outpatient specialists, pharmaceuticals, maternity care, and necessary emergency room visits and hospital admissions. Dental care is generally not covered, but there are some exceptions not elaborated on here. (1)
The health department does a lot of work on preventative care to keep patients up to date on vaccinations and screening tests. Physicians play a large role in the health department. The health department in San Giovanni in Fiore takes measures to ensure clean air, water, and soil for the community. I was so impressed by the volume of work that the public health office does to keep the community members healthy. The local office was daily by a large amount of community members.
General practitioners (GPs) are considered the "gatekeepers" of the Italian healthcare system. They can be family medicine physicians or pediatricians. Family medicine doctors are individually responsible for 1500 patients each while limited to 800 patients for pediatricians. That limit is set by the national healthcare service. (2) Patients are required to register with a GP. They may choose any physician whose list has not reached the maximum number of patients allowed. GP offices are often crowded with patients seen in order of arrival instead of appointments. I appreciated this first-hand last week!
Co-payments are required for diagnostic procedures, some pharmaceuticals, outpatient visits with specialists, and non-urgent interventions in hospital emergency departments. Each region establishes its own co-payment rates for pharmaceuticals, with various exemptions for some population groups such as lower income, chronic diseases, HIV, and other rare diseases. For example - visits to a general practitioner (GP) are generally free, while those to specialists may require a co-payment of EUR 12.91 to 20.66. Prescription medications vary in cost depending on their necessity for the patient's disease. Tier 1 (Class A) includes lifesaving drugs and treatments for chronic conditions. These drugs must be prescribed by a physician, and are generally fully reimbursed by the SSN. However, some may require a small copayment that varies across regions. Class C includes all other pharmaceuticals acquired either with or without a prescription. They require complete payment by the patient. (2)
Health care systems are incredibly complex across the world. I will be honest in saying that I do not understand the United State's system to its fullest. However, it is interesting to be here in Italy because it is consistently ranked one of the best health care systems in the world. The cost of patient care and medical education here are drastically different than the USA.
This is why I am thankful for medical exchange opportunities.
I am also thankful for elementary school lunch. This week's menu was pasta figole, polpetta, patatine fritte, and pane. Yum!
In addition to healthcare experiences this week, we had more opportunities to explore Calabria this weekend. We spent some time exploring some of the historic castles in the area with our wonderful hosts Paolo and Gabriella. Calabria is such a unique region of Italy because there is access to the sea and the mountains within a 40-minute drive. Both are beautiful sights to see.
Le Castella is a small beach village on the Ionian coast of Calabria. A major site to see is Fortezza di Le Castella, a 15th-century castle that sits along the coastline from a narrow strip of land. It served as a shelter for soldiers being invaded by the sea. The foundations can date back to the Magno-Greek period (400 BC) while the superimposed building blocks were likely influenced by the eras of the Normans, Swabians, Byzantines, Angevins, and Aragonese. There is an adorable little gelateria just a short walk from the castle where I enjoyed some stracciatella gelato. Delicioso!
Castello de Santa Severina sits in the city of Santa Severina and dates back to the 11th century. It was a military fortress subjected from 1994-1998. The castle was built atop Greek-aged materials as well as a Byzantine church. It now has artifacts on display as well as beautiful platforms displaying panoramic views of Calabria. It can also function as a conference center, concert venue, and place for art exhibitions. Before our castle tour, we dined at La Locanda del Re with a beautiful selection of antipasti and pasta with porcini (of course!). It is located towards the base of the castle. Another wonderful meal.
We finished the Sunday with my first Tartufo gelato experience. Tartufo translates to "truffle". As a dessert, Tartufo is a hand-molded lump of gelato with chocolate ganache in the center. I was in heaven with my pistachio serving! This will not be my last Tartfuo!
I have one more week in San Giovanni! Time has flown. I have learned and appreciated so much. Thankful to be here with such wonderful people.
Ciao! 🇮🇹
References:
(1) Ferre F, de Belvis AG, Valerio L, Longhi S, Lazzari A, Fattore G, Ricciardi W, Maresso A. Italy: health system review. Health Syst Transit. 2014;16(4):1-168. PMID: 25471543.
(2) Tikkanen R, Osborn R, Mossiallos E, Djordjevic A, Wharton GA. (2020). International Profiles of Health Care Systems. The Commonwealth Fund. https://www.commonwealthfund.org/sites/default/files/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020.pdf.
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