I am sitting in the doctor’s office for what feels like the millionth time over the past couple months. We got about two feet of snow over the weekend and it’s freezing outside. Listening to the chatter it is easy for me to zone out as most of the conversation is in Piemontese (local dialect) and I understand about forty percent of what is said. I have been meaning to post something since Halloween and life just keeps getting in the way so “abbia pazienza.”
Just like everywhere else in the world, life has its difficulties.  The last few months have been full. Between tours, health issues, a minor car accident, (one of the reasons for repeated trips to the doctor) and the mundane tasks of daily life, I have not had much extra time or energy to work on my blog. Sitting here today, I figure I can at least write about how our basic healthcare works.  What do we do when we need a doctor but not a trip to the ER?
We start with our family practitioner. Healthcare in Italy is managed on a regional level (think States) and also receives federal funds. Some regions manage their systems better than others, and, at least from my perspective, Piemonte is one of the better ones.  We sign up for our family doctor at ASL (Azienda Sanitaria Locale), the office where they manage regional healthcare. You understood the word local there, right? It has different names in other regions and it ties into the federal system. I can go to any hospital in the country and have my healthcare covered.
I have had the same doctor since 1999. He is one of three family docs in our village. He is competent enough and will probably retire within a few years…It is probably time.  The biggest complaint I have about my doctor is that he is usually late and not because he is busy working.  He lives 5 minutes from the office and probably works hard on his morning coffee and newspaper before rolling into work.  If it bothered me enough, I could find a new doctor.  I can choose any doctor in our region as long as they have room for new patients but from a practical point of view, having my doctor in the same village is handy.
What is required of our family practitioners from a practical point of view?  A doctor can have up to 1500 patients and the office must be open 5 days a week with a combination or morning and evening hours, Monday through Friday. A doctor with less than 500 patients has to be available for at least 5 hours each week, 500-1000 patients for 10 hours, and from 1000-1500, at least 15 hours each week.  A doctor gets to decide whether they want to schedule appointments or just keep office hours. The latter is more common. When you need to go to the doctors all you do is show up, ask who is last in line for prescriptions or visits, and wait.
The first half hour is to fill prescriptions and goes quickly.  A prescription might be for medication you take regularly, but can also be for a visit to a specialist or for exams.  Last week I came here to close the insurance documents from the car accident I had and to follow up on some blood work.  That was considered a “visit.” I need to schedule an appointment with an endocrinologist so I asked for the “impegnativo,” to have that done. Had I only needed the “impegnativo,”  I would have passed with the “prescriptions.”  Now that I have the necessary paper in hand, I can call ASL to schedule the appointment.  Clear as mud? Here are some examples of what our impegnativi look like…



Today I am here for a sinus infection and have been waiting for about an hour. It is almost my turn…the most I have ever waited is two hours. Not my favorite way to spend the morning but I have had appointments in the states where I have waited nearly two hours past my scheduled time so it doesn’t really bother me since I know what to expect.
After the first half hour of filling prescriptions, the visits begin.  Today there are three people ahead of me.  If someone is too sick or immobile to go to the doctor’s office but does not need to go to the ER, our doctors are required to make house calls after their normal visiting hours and on Saturdays even if their office is closed. We do not abuse the house-call benefit.  The last time I asked for a home visit I had a fever of 104 and did not want to go anywhere. Our doctor has come to the house 3 times in 20 years and the doctor gets to decide if it is necessary.  If they know their patients, they also know if someone is taking advantage of them.
The average family practitioner in Italy has 1200 patients and earns about $4100 per month.  Considering the fact that an average monthly take home salary here is $1400, it is a good wage.  Add to that to the fact that doctors here usually practice privately on the side if they have a specialization (mine is a Pulmonologist), they do not have huge insurance bills (liability and malpractice), and they are able to finish medical school without huge debts.
When I leave here today, there will be no bill, nor paperwork to file with the region. I will have a prescription if necessary and since my husband needs some blood work done; I will get the impegnativo he needs to take to ASL, killing two birds with one stone.  By the time I get home, two hours have passed.
Overall, I am quite happy with the healthcare system we have here.  I always cover this topic with my groups while on tour.  It creates some lively debates. As for life and writing…abbia paienza. I do not know if life is going to slow down any time soon.  I really appreciate the time and support from all of you who are following my blog and will try harder to write more consistently…grazie!