Healthcare in Sicily

In 2020 my husband and I retired and permanently relocated to Sicily. It was a bold move and people are naturally curious, often asking what we miss about our previous lives in the United States. Of course, there are a few things we miss, but healthcare is not one of them.  In our experiences, healthcare in this part of the world is vastly different and far superior. Many Americans find this difficult to believe, especially since we live in Sicily, a place that often gets a bad rap. I’m here to set the record straight.

During the past three years, we’ve used Sicily’s healthcare system on several occasions, and for entirely different medical issues. Frankly, I’m blown away by the accessibility, affordability, and quality of care, compared to the United States, where I was born and lived for 62 years. I’ll give some examples.

In Oregon, where we lived for 15 years before moving abroad, I sought treatment for a sore knee. An MRI was necessary to determine the cause, but the insurance company refused to pay. Without insurance, it would have cost roughly $1,200, which I couldn’t afford. Arthritis was the suspected culprit, but without an MRI we couldn’t be certain. I was told to take anti-inflammatories, as needed, but with caution. If the pain worsened, they said, we would discuss knee replacement surgery.

On this, and many other occasions, I never actually spoke with a doctor, as they are often unapproachable and highly guarded in the United States. Instead, after waiting weeks for an appointment and another 45 minutes in the lobby, I was granted ten minutes with a nurse or a physician’s assistant. Sometimes, I was limited to only two questions before being ushered out. It felt like being at a restaurant when staff are eager to give your table to the next customer.

Each visit included the requisite proof of insurance, paperwork, and co-payment, despite a hefty monthly paycheck deduction for health insurance. Naturally, I visited various clinics in the United States for various ailments over the years. More times than not, it was an expensive and unpleasant experience with an unsatisfactory outcome.

I used the knee problem as an example because in Sicily, it became much worse. My joint pain was so bad, I could barely make it up to the barn to feed my precious donkeys each morning. Our little farm, which is carved into a hillside, and Sicily in general, is made of steep terrain and many stairs, wreaking havoc with my knees.

As an Italian citizen, gained through ancestry, I had two options for seeking medical treatment. I could see a private doctor right away and pay more, or I could wait longer to see a public doctor and pay less. Neither one requires insurance. In this case, I chose the faster route. Later, I’ll describe what happened when we chose the other option.

Private Healthcare

I was able to schedule a visit with an orthopedic surgeon at a local hospital almost immediately. He spoke a bit of English and I spoke a bit of Italian, but when it came to more difficult medical terms, we resorted to Google Translate. The exam was thorough and unrushed. He suspected a mechanical problem and suggested an MRI. Two days later, I walked into a state-of-the-art facility and paid 180 euros (roughly $200) and was handed the magnetic resonance image of my knee on a CD. There was no hassle, no insurance, no paperwork, and I was able to keep the image to share with whomever I chose. 

With the MRI results in hand, I texted the orthopedist who had given me his personal cell phone number at my previous visit. Imagine being able to communicate directly with your doctor! In less than 48 hours, this highly skilled and respected surgeon was sitting at my kitchen table with his laptop, patiently explaining what the image showed. Yes, you read that correctly; he made a house call.

The doctor was correct, the issue was indeed mechanical and not caused by a degenerative disease as assumed in the United States. Due to a structural problem, my knees had a habit of slipping off to one side rather than gliding smoothly along the trochlear groove, resulting in damage to the cartilage over time. The doctor assured me that we could remedy this condition without medication, cortisone shots or surgery. He returned to my farm a few days later to inject hyaluronic acid, a natural and harmless lubricant, into my knee joint. After the first injection, I climbed stairs pain-free for about 6 months. The cost was 150 euros per knee. He also recommended a stationary bicycle to strengthen the surrounding muscles.

Now, I simply text the doctor when the pain returns and he administers the injections, sometimes in one knee, sometimes in both, in the comfort of my own home. Each time the relief lasts longer; currently, about a year. I enjoy what is essentially a concierge service, but without the exorbitant price or need for additional insurance. Mind-blowing, right?

Ironically, these injections are only approved in the United States for osteoarthritis of the knee, a diagnosis that requires an MRI, which I was denied. Even if the insurance company had approved an MRI, these highly effective injections would not have been authorized for a mechanical issue so the outcome would have been the same.

My amazing experience with an orthopedic surgeon was not a fluke, as I had a similar situation with a private dermatologist for a case of contact hand eczema. His office included a waiting room, which was empty, and an exam room with a lovely view of the Ionian Sea. There were no other employees besides the doctor himself. The appointment occurred on time and without insurance or paperwork. The cost was 80 euros for the exam and 31 euros for two prescriptions that resolved my problem.

Public Healthcare

On another occasion, we tried using the public healthcare option. In this case, my husband, a former smoker, was interested in seeing a pulmonologist to check his lung capacity. While his lungs had improved greatly, there was still cause for concern, but it wasn’t urgent. We began with a visit to our general physician, which was free, who gave us a referral to a lung specialist within the public healthcare system. Making the appointment with a specialist through this system was a bit more complicated, and given our poor Italian skills, we needed to enlist the help of a friend.

There was a two-month wait for the appointment and we had to drive to a clinic about 40 minutes away. Unlike previous visits to private doctors, we had to first stop at a reception area to show the referral and our Tessera Sanitaria (public health card). What happened next was a bit odd and confusing. 

We were instructed to go to the post office where we had to pay 22 euros and fill out a form. We then rushed back to the clinic, hoping we would still be able to see the doctor, as it was now an hour past our original appointment time. The secretary accepted the receipt from the post office and sent us to an upper floor where, she said, we would find the pulmonologist in Room #3. The doctor examined my husband right away and prescribed a new inhaler, one that is said to help reverse lung damage. All our prescriptions, thus far, had cost less than ten euros. This was the exception, costing 49 euros.

A Word About Pharmacies

Pharmacies are managed more efficiently in Italy, as well. Medications are pre-packaged in blister packs so there’s no waiting for pills to be counted, bottled, and labeled for individual patients. Each box is stamped with its production and expiration dates and includes a detailed information sheet inside. And there’s no need to wait for the clinic to fax the prescription to the pharmacy. In fact, refills are easily achieved by texting your doctor directly, who then texts back the new prescription with no additional office visits required. Prescriptions don’t need to be printed; you simply show your phone to the pharmacist.

Oddly, veterinary prescriptions for our pets are also purchased at the same [human] pharmacies.

Healthcare in Other Parts of Sicily

Friends who reside in different regions of Sicily report the same positive experiences. My girlfriend, who suffers from severe migraines, has been thrilled with the quality and affordability of the treatment she’s been receiving here, versus New York.  In the United States, she was constantly battling insurance companies and dealing with expensive medications that she could only afford if she was lucky enough to find a coupon. The stress caused even more migraines. Often, doctors simply told her to get a massage because there was nothing they could do. You can read her story here:

https://www.ahouseinsicily.com/post/a-medical-story-in-sicily

Another friend living in Sicily, who suffers from diabetes, tells me that everything she needs to manage her disease is provided at no cost. I can’t help but think of an old college classmate back in Arizona, who also had diabetes. The expense of student loans and treatment for his diabetes was so high, he was forced to move back in with his parents at the age of 47.

Summary

While we found the private pay-as-you-go healthcare system to be more efficient and less complicated, the public system also provided a good service. Both options were affordable and of high quality. Neither required insurance.

The sharp distinction between healthcare in Italy and the United States is undeniable. The reason healthcare in Italy is superior is because in this part of the world it’s considered a basic human right, rather than a run-for-profit business. Point made.