Italy has the highest number of doctors (medici) per head of any country in the world (one for every 160 inhabitants), and they're generally well trained and professional. Not surprisingly, however, it's difficult to find English-speaking doctors in some areas of Italy, although most cities and resorts have a medical service for tourists (guardia medica turistica) with English-speaking staff. Embassies and consulates in Italy keep lists of doctors and specialists in their area who speak English and other languages, and your employer, colleagues or neighbours may also be able to recommend someone. If you live in Milan, the International Health Center (( 02-720 040 80) has a number of English-speaking medical specialists.
General practitioners or family doctors (medici generici) are listed in yellow pages under Medici Generici, and specialists under Specialisti and their speciality e.g. Ostetrica e Ginecologia (obstetricians and gynaecologists). Note that the word dottore is a courtesy title used to address any university graduate.
If you wish to take advantage of the national health service, you must register with the Servizio Sanitario Nazionale (see Registration above). When registering, you're required to choose a family doctor with a social security agreement (medico convenzionato) and, if you have children aged under six, a paediatrician (pediatra) also. Local health authorities provide you with a list of doctors with whom you can register and you can choose any doctor who's willing to accept you (there's no requirement to register with a doctor within a certain distance of your home). Each member of your family is issued with a national health number and a health card (tessera sanitaria), which you must take with you when visiting a doctor or other health practitioner.
In addition to single private practices, family doctors also practise in group surgeries known as poliambulatori. Group practices can be either state, operating within an Azienda Sanita' Locale (ASL) building, or private, and they offer a range of specialities usually unavailable at doctors' surgeries. These may include allergology, cardiology, dentistry, dermatology, gynaecology, ophthalmology, orthopaedic treatment, physiotherapy, psychotherapy, radiology, sports medicine, surgery, and urology. For a list of group surgeries and hospitals in your area, contact your local health authority.
You can make an appointment to see a private doctor, specialist or consultant at any time, provided you don't mind paying for their services. This means that you have total freedom of choice and can obtain a second opinion, should you so wish. In Italy, many family doctors who work for the national health service also work privately as specialists, and it's quite common for family doctors to suggest that you see them privately for specialist treatment; in this case, you will normally visit them at their private surgery (studio medico), which may be separate from their state practice. Unless you know exactly what the problem is, however, it's wise to see your family doctor first. To see a private doctor or specialist, you may need to pay an initial registration fee (around â‚?2) plus a fee for each visit, which may be anything from â‚?0 to â‚?60. Note that you're normally expected to settle the bill in cash immediately after treatment, even if you have health insurance. (It's important to keep all medical receipts, as these can be offset against your income tax bill.)
Doctors' surgery hours vary, although surgeries are usually open from 8 to 10am and from 3 to 5pm, or there's one surgery only from 8am to 1pm, Mondays to Fridays only. Appointments aren't usually required and most surgeries operate on a first-come, first-served basis, so it's recommended to arrive early to avoid a long wait. Your family doctor will diagnose your problem and may write out a prescription (ricetta) for you to take to the chemist. He will arrange for you to have any necessary laboratory tests or X-rays at an authorised medical centre. If he thinks that you need to see a specialist, he will refer you to one who's registered with social security. He then writes a referral (impegnativa), which you must take with you if you wish to be claim social security benefits. If you want a doctor to visit you at home, you must telephone during surgery hours. House calls made by family doctors are free during normal working hours.
If you require specialist medical attention and want to take advantage of social security benefits, you must take your doctor's referral with you when you attend your appointment. Your family doctor may suggest a specialist, but you can also choose your own. Specialists registered with the SSN have their consulting rooms (ambulatorio) in state hospitals, local health authority buildings or other centres with an agreement with the SSN. Some private specialists, known as privati accreditati, also treat social security patients at their private surgeries. If you have X-rays or laboratory tests done, it's your responsibility to collect the results and take them to your family doctor or specialist, so you must find out when they will be ready.
If you're registered with social security, you must find the cashier (cassa) to pay the subsidised charge (ticket), so don't forget to take enough cash with you; you're then given a receipt, which you must hand to the specialist. The most you will pay for specialist treatment is â‚?0 (some treatments, e.g. X-rays, cost less) and your doctor can request a maximum of six treatments for each referral. Certain categories of people pay a maximum of â‚?.50 per specialist treatment, including children under the age of six, those aged over 65 with a family income of less than around â‚?7,000, those whose annual income is below â‚?,300, and anyone who suffers from a disability or a long-term, chronic illness such as rheumatoid arthritis, diabetes or epilepsy.
If you need the services of a medical auxiliary, e.g. a nurse, physiotherapist or chiropodist, you also need a referral from your family doctor in order to pay the reduced amount (ticket). If you don't, you must pay the full cost. Depending on where you live, home visits by nurses (for example, to administer injections) may not be covered by social security and you may need to pay the full cost.
If you're away from home and need the services of a doctor, provided you visit a doctor who's registered with the health service, you won't need to pay for his services. He will write a request (richiesta) on headed notepaper, which you can then take to your own doctor and exchange for a referral if medical treatment is required.
This excerpt has been republished with permission from Survival Books. Some of the information may apply to EU citizens only. If you would like to get the inside track on moving to Italy, pick up your copy of this great book by clicking here.