The Diagnosis:
In the middle of the COVID 19 pandemic, it’s easy to forget that there are other illnesses that are still prominent. It seems that now whenever one gets sick, the primary thought is, “I hope this isn’t COVID!” My reaction was no different; after my lovely spring break in Sorrento, I began to feel sick. Days went by and my symptoms got worse until I eventually called a doctor and was diagnosed with mononucleosis. AKA “mono.”
For most people they would see this diagnosis and be concerned only with the steps to getting healthy. For me, a lower middle class individual who doesn’t have health insurance; my thoughts were different. I was only concerned about the cost. I would often go to the pharmacies and ask for the cost of my medicine prior to even purchasing it. I was thrilled to hear that mono does not require antibiotics because in my experience, those can be costly.
Getting Medical Treatment – Abroad VS. The United States:
When I am in the United States and I am sick, I first wait to see if my symptoms magically go away and if they do not, I bite the bullet and spend the extra money for an evaluation from a doctor. I am, however, in Italy and had never navigated their healthcare system. I was lucky though, being a student at Temple University Rome meant I had insurance. So the path from sick to well was a little more pronounced and nowhere near as costly as it would be if I were back home. As a Temple Rome student, my process with Italian healthcare was as follows:
- Calling International SOS and making an appointment with a doctor
- Getting a check up (Once initially and another before being cleared)
- Taking a blood and swab test
- Purchasing two over the counter medicines upon diagnosis
- Getting an ultrasound to ensure both my liver and spleen were not dangerously inflamed
Hearing about this process worried me greatly. I already have a very tight budget, especially since I am nearing the end of the semester and have exhausted a lot of my funds. I also know that without insurance, the costs in the United States can be behemoth.
- Up to $200 for a check up
- Up to $40 for a blood test for mono
- $300 for both medicines I had to purchase
- $410 for an ultrasound
- Total ≈ $950 USD
I was relieved to hear that through International SOS, I would have a guarantee of payment that ensured I would have access to the resources I needed and that they would be free or near free of charge. The whole process did indeed end up being completely free with the support of International SOS. This luxury of mine was solely predicated on being a student at Temple University. This motivated me to research two things: How Italians without insurance navigate the healthcare system and how refugees and asylum seekers would have to operate in the Italian healthcare system. I had some readily available resources that facilitated the whole experience, but how exactly do others navigate?
Italian Healthcare:
Unlike the United States of America, Italy is a mix between a private and public healthcare system. In private healthcare systems, healthcare organizations are not owned or directly controlled by governments. In public healthcare systems, care is usually provided by the government through national healthcare systems. In Italy, citizens have the liberty of choosing how they conduct their business in the healthcare context. They can hire a private doctor or go to a walk-in appointment using a public one. Most Italian citizens choose public healthcare because it is significantly cheaper and the luxuries of private healthcare, like private doctors, planned appointments, etc. are not seen as a priority. In the bulk of my findings, I concluded that overall, healthcare in Italy is more accommodating than in the United States when it comes to costs.
Upon doing some more research, I was even able to find this statement in Article 32 of The Italian Constitution: “The Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent.” (https://pubmed.ncbi.nlm.nih.gov/26252268/) This essentially means that anyone in Italy who needs help is eligible to get it. In the United States there are a multitude of people without healthcare coverage or who aren’t being treated because they cannot afford it.Permanent residents and citizens will get healthcare in Italy upon registration through, “Servizio Sanitario Nazionale” (SSN).
Healthcare for Refugees and Asylum Seekers:
Now despite the accommodations, there are still some healthcare discrepancies when it comes to the refugee and asylum seeking population in Italy. The healthcare system can be inundated with barriers for refugees and asylum seekers. These barriers include language, not all refugees and asylum speakers can easily communicate their health needs. Another barrier is lack of healthcare information. Doctors spend as much time documenting medications for their patients as they do treating them. In the case of both refugees and asylum seekers, it can be difficult to navigate their health needs because there is not an explicit history of medications they have taken, allergies, or effective treatments.
It’s also important to consider that refugees and asylum seekers do not always have stable housing. Housing is a fundamental part of the process for registering for the Italian healthcare system. This sometimes leaves refugees with fewer options than Italian citizens. They could still get general care potentially, but would have to seek some of the following programs in their area. For example:
- MEDEU (Medical Doctors for Human Rights)
- INTERSOS – Provision of social and health assistance also to groups in conditions of marginality including unaccompanied and separated children
- MSF (Medici Senza Frontiere – Doctors Without Borders) – for medical care and assistance in various locations in Italy, also for psychological assistance
These resources, however, are not always readily available and sometimes underfunded and understaffed. Both factors can make it difficult to maintain these programs and in turn make it harder to keep these resources accessible. Fortunately, in the event of an emergency, someone can be treated regardless of citizenship, but this does not omit the issues discussed above.
Healthcare For Italian Citizens:
I am fortunate enough to have family in Italy (All Italian Citizens) who shared some personal anecdotes about some of the issues they faced with Italy’s healthcare as less financially stable citizens. According to my family, the healthcare system always offers quality care, but the speed with which one gets assistance can be poor. With the pandemic, hospitals are inundated with patients, my cousin added that some of the long wait times may be predicated on that. With private health insurance, you can schedule an appointment and be seen right away. If you need to get tested for something, you will be seen in the lab, examined, and likely have your results by the end of the day. This was the case for my experience with student health insurance. Without insurance you may sometimes have to wait in lines that go “out the door,” according to my cousin. When waiting for the results of tests, it can be hard to navigate because if you don’t have your diagnosis, the doctor can not make a suggestion as to how to go about getting better. Sometimes citizens may have to wait out their condition until a result is reached. My cousin claimed that though he is happy overall, he finds himself frustrated with time specifically and his friends and family would agree.
Despite my cousin’s relatively fond reflection on Italian healthcare; the case would likely vary for refugees and asylum seekers. Primarily, registering for public healthcare is not as simple as it is for citizens. The process is a lot longer because of things like language barriers and a lack of medical history. The resources also may not be as abundant if a non citizen doesn’t have stable housing or lives in a reception facility. Refugees will only be granted immediate care in the event of an emergency, but even that becomes obscure given how an emergency is defined. Of course something like cardiac arrest would be treated immediately, but what if an individual wanted to have a mole checked that could be potentially cancerous? It’s these types of things that may not always be considered and that’s why it can be exponentially harder for non citizens.
By contrast, I hadn’t experienced grand wait times or delayed testing results. Nor did I have to register for any type of care as I am not a citizen. I had insurance and thus I could schedule appointments and get my results and treatments promptly. I got my medication for free and even had some procedures that also cost me nothing.
As someone who is of a lower class family and income, I would say that lack of insurance in Italy is far more convenient than it would be in the United States. That being said, I realize a lot of my prosperity was heavily predicated on me being a student of Temple University. I had luxuries that lower class Italians and refugees don’t always have. There are many adversities I face being financially insecure, but I am very fortunate to have resources like Student Health Insurance while abroad because they help me tremendously.