My experience with Women's Healthcare in Italy vs. the US

What if the greatest barrier to your health wasn’t biology, but your country of birth? As someone who is very passionate about women’s health due to my personal history, I was very cautious about moving to Italy and receiving care in a foreign country. Needless to say, other than the language barrier, I had no reason to be worried. Here in Italy, without the barrier of privatized insurance, I have been receiving excellent quality care for less money than I spent in the US.

In an age where healthcare executives are being shot on the street, and celebrities are hosting “go fund me” pages to pay for care, it’s time to ask: what is stopping Americans from adopting national healthcare? What are they so afraid of?

One large and important caveat: I am not on the Italian National Healthcare system. I have private insurance and visit doctors via their private rates, and am later partially reimbursed through my international insurance coverage. I recognize this is a privilege many Italians cannot afford. I cannot speak to what the National Healthcare System is like, but I can speak to my experience visiting doctors, getting bloodwork and testing, and ultimately getting pregnant in Italy after severe women’s health issues.

Italian healthcare is focused on delivering quality care. The US is focused on profit.

I truly believe I got pregnant because my Italian doctors made a care plan for my specific situation. For example, in the US, a fertility patient will go through a series of diagnostic tests, like a Saline Infusion Sonohysterogram (SIS) or Hysterosalpingogram (HSG) as standard first-line tests. My Italian doctor skipped these procedures and instead immediately had me do a hysteroscopy to investigate the root cause of my symptoms. I was able to be diagnosed and have a treatment plan much faster than my peers back home. Without the fear of insurance coverage for testing, Italian doctors can make the best choice for your particular situation. Not to mention, the doctor who performed my hysteroscopy used a relatively pain-free technique and is recognized as one of the global leaders in this procedure.

Another example would be for breast health. During a screening, I felt a lump, and I saw a doctor who recommended I get an ultrasound right away. In the US, breast ultrasounds are not generally recommended and not covered by health insurance, because they are deemed “diagnostic” and not “preventative,” despite the fact that they can catch cancer missed by mammography, specifically for those with cysts. I need to go back for imaging every six months, and I do worry about how I will continue to monitor this once I return home to the United States.

Because Italy has a National Healthcare System, the costs are very transparent, even for someone like me paying the cash price. For example, an ultrasound costs 100 euros. My sister, who has a high-deductible plan in the US, had to call around for pricing when she was prescribed an ultrasound, and the cheapest option was $1200. I wondered if she was buying the ultrasound machine itself. Since healthcare companies and insurers are working for a profit, and there is massive administrative overhead, the cost will always be passed on to the patient.

In terms of comparison, the OECD ranks Italy consistently higher in quality of care, and people have a higher life expectancy, despite lower spending than the US (source).

The US has a focus on cultural competency and consent

When I first started seeing doctors in Italy, I was surprised by how little “bedside manner” there seemed to be. Here in Naples, there were many people in a room, and I had no idea if they were students, residents, doctors, or nurses. The implication is that the patient should trust the provider who has the skills, training, and education to bring them a solution.

Meanwhile, in the US, there is a standard introduction that is performed by a provider when seeing a patient. I am usually addressed by my full name and go through a series of questions regarding my preferences (I am John Doe and I am a nurse practitioner, do you consent to this person being in the room for training, etc.). Then, you normally have to sign a million consent forms with details about what the potential risks are to avoid malpractice lawsuits, which are common and well compensated in the US.

Because I am used to a certain level of “procedurisms” in the US, the Italian system can sometimes feel “unofficial”. There is no online patient portal - I keep all of my records on paper and bring them to my appointments. It has been rarer to receive post-operative instructions or packets of information to take home about what to expect.

Italians do not give pain medication easily, but are happy to offer homeopathic alternatives. The US has more comfort measures.

Both in Italy and the US, I have had to do a few medical procedures that required me to have “twilight” or IV sedation. In the US, they just give it to you. In Italy, you have to do a thorough pre-screening with a physician before you are approved to receive these drugs. This usually includes an EKG or electrocardiogram to make sure your heart is healthy, bloodwork that shows healthy levels, and an interview discussing any other health issues and how you are managing them.

Meanwhile, in the US, sometimes doctors will even give you anti-anxiety medication on your way down to the operating room! A few times, I’ve been iced out in Italian hospitals, stuffed in a supply closet while waiting to go into the OR, trying to remain calm.

In Italy, I remember after my hysteroscopy, which required antibiotics, I was not offered any pain medication or anti-anxiety medication. I was, however, prescribed probiotics as well as boric acid to prevent infection. This is something I would do on my own in the US, but I was shocked that it was prescribed as part of standard post-op care in Italy.

The US Needs to Adopt a National Healthcare System

I have been very lucky to receive excellent quality healthcare in Italy, which I believe is a fundamental human right. It is my personal opinion that the US needs to move to a national healthcare system. Cultural competency and patient education will always be important in the US compared to Italy, considering the diversity and sheer number of people. However, choosing to test and diagnose based on reimbursement rates is harming not only patients but also doctors. Doctors need to focus on the quality of care, not on calling and writing letters to insurance companies to beg for approvals. Patients need to focus on wellness, not arguing with insurance companies about coverage. The infiltration of private equity into healthcare should be more alarming to the general population, as the entire system is put under stress. It is unacceptable that a country with the resources we have can send the average American family into financial ruin because of one emergent health situation.

For those who worry about wait times, the concern is real. Anecdotally, from what Italian friends have told me, wait times to see your medico di base (GP) and specialists are much longer. However, in terms of perceived quality issues, I believe these to be unfounded. Not to mention, there will always be an option to adopt private insurance for those, like me in Italy, who need “extra” supplemental insurance.

What do you think? Have you ever experienced healthcare in another country? What was your experience like?

More reading:

• You Shouldn’t Have to Beg Strangers for Money to Survive a Health Care Crisis by

• Everything is private equity by

• While women struggle to have basic preventative medicine covered, men can be prescribed Viagra and GLP-1s via telemedicine now, and healthcare has turned into a private equity cash flow. Private equity has had devastating effects on healthcare in the US, increasing costs for patients and decreasing their quality of care (for more information about how ingrained private equity is in the US healthcare system, check out this article).