As for all of the test results and documentation I have to carry around, I have come up with a solution. I return from the U.S. bearing something that I hope will simplify my life and make me the envy of the other women in the maternity ward waiting room with their collection of documents stuffed into flimsy transparent file jackets meant to be put in those lame three-ring binders from the 1970s . Yes, it's a pink Trapper Keeper, people. I haven't been in school for about a decade now but I am a sucker for school supplies, especially those put out by the Mead Corporation, which was founded in my hometown. Though who knew Trappers cost $20 now? No matter. I have already organized everything in my turbo-charged binder (had I spent a little more, I could have had one that recorded sound files as well) with its handy flaps, zippers and velcro and I feel ready for my next gynecological visit. Want to see my health card? It's right here in the Trapper. The DVD of my NT scan? Let me get it out of the multimedia folder. Now if the Trapper only had a place for urine samples...
Monday, August 27, 2007
American solution to an Italian problem
I wrote last month about my frustration with the amount of bureaucracy and paperwork required to get basic medical care during my pregnancy. I have returned to Italy no less frustrated. In fact, I will spend half of my workday today going to the pharmacy (yep, to buy my own urine containers), going to my doctor's office in the hopes that she or a substitute is there to provide me with forms I need to get various tests done and then taking those forms to the hospital where I am still unsure which line/lines I need to stand in or if I will get the "No, you are in the wrong place because [insert reason I could have never anticipated and which doesn't make much sense here]!" run-around. If I lived in the U.S. and had health insurance, all of these things would be taken care of during my routine doctor's visit and I surely wouldn't be buying my own urine containers and then driving my urine (or carrying it carefully though not inconspicuously on public transportation) in stop-start traffic to the lab where the urine may then be rejected for some arbitrary reason, such as the doctor having written up the lab test order making the "u" in my last name look more like an "i," thus necessitating I begin from the beginning with the whole process. Back to the doctor's, back to the pharmacy to buy more urine containers, back to wasting another morning doing a simple urine test...one of a gazillion tests I'm doing during my pregnancy, few of which are ending up being "free" with "free" state healthcare. The last set of blood and urine tests put me back more than 100 Euros. Anyway, there is nothing I can do about all of this. This is the way it works here, and I'm trying to just roll with it.
As for all of the test results and documentation I have to carry around, I have come up with a solution. I return from the U.S. bearing something that I hope will simplify my life and make me the envy of the other women in the maternity ward waiting room with their collection of documents stuffed into flimsy transparent file jackets meant to be put in those lame three-ring binders from the 1970s . Yes, it's a pink Trapper Keeper, people. I haven't been in school for about a decade now but I am a sucker for school supplies, especially those put out by the Mead Corporation, which was founded in my hometown. Though who knew Trappers cost $20 now? No matter. I have already organized everything in my turbo-charged binder (had I spent a little more, I could have had one that recorded sound files as well) with its handy flaps, zippers and velcro and I feel ready for my next gynecological visit. Want to see my health card? It's right here in the Trapper. The DVD of my NT scan? Let me get it out of the multimedia folder. Now if the Trapper only had a place for urine samples...
As for all of the test results and documentation I have to carry around, I have come up with a solution. I return from the U.S. bearing something that I hope will simplify my life and make me the envy of the other women in the maternity ward waiting room with their collection of documents stuffed into flimsy transparent file jackets meant to be put in those lame three-ring binders from the 1970s . Yes, it's a pink Trapper Keeper, people. I haven't been in school for about a decade now but I am a sucker for school supplies, especially those put out by the Mead Corporation, which was founded in my hometown. Though who knew Trappers cost $20 now? No matter. I have already organized everything in my turbo-charged binder (had I spent a little more, I could have had one that recorded sound files as well) with its handy flaps, zippers and velcro and I feel ready for my next gynecological visit. Want to see my health card? It's right here in the Trapper. The DVD of my NT scan? Let me get it out of the multimedia folder. Now if the Trapper only had a place for urine samples...
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19 comments:
Welcome back, michellanea! That trapper keeper is fantastic. I want one just for all the routine paperwork I'm forced to have lying around.
I'm now determined to get private health insurance before we try for a kid. The more I read about your struggles with the supposedly "free" Italian system, the more I know that this stuff would drive me crazy. How do Italians deal with it and why haven't they have a revolution yet?
Kataroma,
Well I'd also be a little careful with the private system though. Private here does not always mean better. It may mean "prettier" or "nice waiting room with magazines," but not necessarily better care or more efficiency. I go to a private gyno and I've realized that there's really NO advantage. I pay this woman 110 Euros each visit - and for what? I still run around doing all of the testing with the state - she doesn't do that stuff in her office and I've never heard of other private doctors here having their own labs. My gyno will not even be present at the birth and was not reachable the two times I had emergencies and had to go to pronto soccorso. I am actually switching over to a state gyno who may not have as pretty an office but is at least affiliated with a hospital. Also, I checked out private clinics for birthing. They ARE nicer (though still not up to American - or I'm sure Australian - standards) but they are not equipped for many emergencies and don't have neonatal units. I got scared and am now going with the good old state hospital where I won't have any privacy or comforts but where I feel the baby will have access to the best care. My first act of maternal sacrifice... :)
Italians don't rebel because they don't know any differently. My experience in talking to Italian women is that they have NO expectations for decent care or being treated like a human being. The other thing I've realized is that Italian women have been made to feel TERRIFIED of the epidural. In talking to all of my female American friends and family members, they pretty much all had the epidural and were never made to feel "scared" about it. They couldn't understand why I'd have such a hard time getting it here.
oh, thanks for the info, michellanea. So, you mean even with private insurance you still have to wait in line for tests etc?
I didn't know that there even were public gynos here. Everyone I know seems to go to a private one. My guy is private but he only charges me Euro 60 a pop (for a checkup, pap test etc.)
I loved having to buy those urine containers but not as much as I loved having to get my blood pressure taken at the pharmacy. I have so many absured tales of my pregant-in-Italy days, I don't know where to begin. I will say, however, that having a healthy understanding of the risks and benefits of the epidural is a good idea. Gearing yourself up for some pain, telling yourself you can and will get through it, goes a long way. Then if push comes to shove comes to I can't push anymore!, you can ask for the epidural. As always, email me whenever you want.
And ditto on the private vs. public care, Kataroma. The system is ridiculous no matter how you go, so find a doctor you trust and like and then leave it up to the pregnancy goddesses.
Kataroma,
Maybe there are private labs? I don't know. But in terms of the convenience of having the doctor do urine or blood tests in his/her office, I've never heard of that happening even in the private system. In theory, much of this pregnancy stuff is free (you should get three free ultrasounds -at about three months, six months and eight months) or at least subsidized with the state. When I paid 150 Euros for my last blood tests, the woman told me I was "lucky" because I'd paid half what a non-pregnant person would have paid. Obviously, things get backed up with the state but I have persevered and gotten appointments - though sometimes at hospitals or clinics that are very far from my house. I refuse to pay out of pocket, though, for something "free" I am paying for as a taxpayer. My (granted, limited) experience with the private system is just that it's nicer - fewer people to a room, etc. - but not more efficient.
Rompi,
Yes, I will email you. I am going to step up my mental game in preparation for an epidural-less birth. I have returned with several yoga, pilates and meditation DVDs. It just makes me angry how brainwashed women seem to be here vis a vis the epidural (or maybe it's the Americans who are brainwashed thinking it's normal?).
oh, the joys of italian healthcare... i hear you!
i pretty much gave up on the public system all together and started hunting down & using semi-private structures. i found a semi-private (or you could say semi-public) blood lab in rome and the prices were slightly higher than public clinics BUT there was none of that waiting for 2 hours in a line with unruly locals trying to sneak in before you, or waiting weeks for the results.
i also found semi-private ob/gyn clinic that has offices all over italy:
http://www.aied.it/4/home.htm
the doctors actually have computers with your records in them, so you don't have to carry around a trapper keeper (though yours is stylish!)
you might want to try these structures too:
http://www.usi.it/
again, semi-private. which means prices are a tad higher but you don't have to wait 6 months for an appointment or test.
it's a constant battle for me trying to find easier, affordable ways to get healthcare without having to resort to the public clinic insanity... i should ask for a refund on my taxes (;
Thanks for the advice michelle and rompipalle (love the name, BTW :)). Here in Rome there are these foreign private doctors where a lot of the more well off expats go but they are crazy expensive. When I first came here as a tourist I went to some of them and they were indeed nicer offices, less waiting and English speaking (which doesn't concern me anymore but did then since I didn't speak Italian then.) I thought that maybe having an American gyno etc might be more bearable than an Italian one - at least there would not be so much emphasis on losing weight etc. But maybe the public Italian gynos are OK? If I had a kid here, I'd probably go to a public hospital at any rate.
Romerican - I was just trying to figure out how to email you as I don't want to take over michelle's blog! Can you tell me approximately how much these 'semi-private' clinics cost? I may have to do that next time.
When I was in Italy I went to a private clinic that had it's own lab. I had to pay for my blood tests, but I was able to get the results in 2 days instead of 2 weeks which the state offered, plus I didn't have to get up at 6 AM and wait in a line, hoping to get one of the few acceptable numbers for a blood draw. It was worth paying for.
are there any private clinics near you?
Glad you had a nice vacation-even if it did rain a lot near the end.
kata:
i left you some info on your blog in the comment section!
Romerican and J.Doe,
I do use some of the semi-private clinics (well, one in particular) and the place is cleaner and nicer with slightly shorter wait times. BUT I am noticing that they are phasing out the taking of impegnative with the state system (meaning they are going fully private as are some of the other clinics that used to take the mutua) and I still have to go back there to pick up my results, etc. Maybe better places do exist but how to find them? I've never heard of anyone up here raving about their favorite private clinic where everything is done efficiently. Mainly I've heard that the private places are "più belli"
Ramona,
Even if you go private, you still need your primary care physician with the state as a reference for many things. To get an impegnativa for prenatal classes at the hospital, for example, I had to go to her. And for all of the blood and urine tests, I still have to go to her for the impegnative. My (private) gyno does not provide me those things.
Sorry to ask so many questions but I have another one. If you use a public gyno, does that mean that you have to see a different person each time?
kataroma
Hi,
first of all, welcome back Michelle, and let me bug you little. Lucky you and all for the fact now I work 8 hrs a day and have not that much time to be on expats bugging you all!
I'm a fan of public. Above all because here in Bologna it's easy, we do really have some of the best hospitals in Italy, and anyway I really don't feel as "one that does not know better". I do know better AND worse ;)
And honestly, I think Italian health care is not so bad. There is not much bedside manners, true, but the care is among the best, and anyway paying a "ticket" does not mean our healthcare is not free. It is not free for anyone (which is different). It is "free" for whom needing urgent care (did they ask you to pay Mich, when you went to the Pronto Soccorso? If they asked you - and I'm almost sure they didn't- it meant you were not judged "grave" or really needing immediate care)or for the poorer. And I feel right I pay a little (and I say a little) for the ones who cannot pay or need very urgent or life saving cares. When I had my appendicitis taken, I paid zero. For your pregnancy and labour, you will pay zero...and so on...
Maybe there are places (Australia, UK I don't know) where for blood tests you pay zero, ok honor to them, here I feel good I pay a ticket letting my mother, who is over 60, having everyting, medicaments included, completlely free as any other over 60.
But this is a very, very long story, with many flaws and many excellences, and I suspect discussing with me the dark and bright sides of the sanitary system nr. two in the world (OMS)is not your first concern now, nor mine, since I marry with Gabriele in 20 days and I'm likely to plan a pregnancy for which I'm THANKFUL of being born in Italy AND in Bologna.
Kata, I always have the same gyno in public hospital in Bazzano, if I require it at the moment I take the appointment at the CUP (Cntro Unificato Prenotazioni).
Auguri per tutte.
Un saluto
Chia
p.s. my new workplace with interesting infos on Sanità too: http://www.regione.emilia-romagna.it
chiara,
you are lucky enough to live in a region (emilia romagna) with the BEST healthcare in all of italy- that's a fact. but if you go slightly south you'll find an entirely different situation, i can assure you as i live in rome and have dealt with the HORRIBLE, inefficient system. and i'm not talking about bedside manner here, i'm talking about serious medical errors and malfunctions. Free or partially free healthcare is great - IF it works. if it doesn't work throughout the entire country then something needs to be done. it's not fair that you & i pay the same amount of taxes but you get excellent healthcare while i get third-world quality. That's the point.
Chiara,
I too am a fan of the idea of public health care and believe that a civilized society should offer health care to all. I think the U.S. system is absolutely flawed and while it works fairly well if you have insurance, I would never say how "proud" I am of the great health care one can get there just because of the glaring access problem. Unfortunately, I see very little to be proud of in Italy except for the fact that the Italian system provides access to all who need it. I spent the night in the ER last week, and it was by far, one of the worst experiences of my entire life. I do not want to get into it on my blog but I was horrified by what I saw and experienced. Thank God I was delirious for most of it but my husband was wide awake for all of it and, believe me, he was not waving his tricolore flag. Una vergogna veramente.
Ramona,
I have some more information on how one gets an appointment with a specific specialist through the pubic hospitals if you want to email me privately.
I recently had a miscarriage, went to a private gyno, and had to bring the *miscarry* to the hospital for labs (the next morning!). Don't feel bad about having to bring your own pee. ugh!
I didn't really see the benefit of the private gyno, except I went to an office, not the hospital. She was nice, and spent some time talking to us, so maybe that is a benefit. However, in the end, I did have to go to the hospital for blood tests, and like I said, bring the miscarry, so they could test it, and at the end paid 150 euro, plus 60 for tests.
michellanea - I spent the night in ER at Policlinico in rome about 2 years ago and, while I wasn't as sick as you (just an extreme allergic reaction to aspirin) it was truly scary and the reason I'm so scared of being in an Italian hospital in general.
Some things which happenned that night:
1) a well dressed woman stole my wallet from my handbag - next to my gurney. I was too weak/sick/hooked up to an IV to stop her.
2) at 3am I was suddently turfed off the gurney they'd stuck me on in the hallway because someone was dying and they needed to put him there. I was stark naked under a sheet, covered in huge hives and hooked up to an IV. No one helped me unhook the IV and get dressed until I started screaming at them.
3) I ended up in a room full of very sick, old people sitting in chairs.
3) the bathroom was filthy and there was no toilet paper or soap. This is the same hospital where the Espresso reporter later went undercover and found that someone was stealing all the money meant to be used for cleaning.
4) when it was time for me to leave, I couldn't find a single nurse to "check out" with. I found them all sitting in a back room chatting and playing games on the computer.
5) the ER was full of really sick old people dying on their own. Family members were turfed out at midnight. :(
kataroma
My private doctor has an ultrasound in his office, which cuts down on the amount of running around I need to do to have tests done. I'm thankful for that but I went through a couple of months when getting impegnative, having tests done and collecting results was almost a full-time job! I haven't looked for private labs just because I don't want to have to pay extra for a service I'm entitled too either. Fortunately the costs down here in Campania are lower than in Lombardy. So far I've only spent about 250 Euro on my tests (not counting the amnio.)
Michelle, I am so envious of the trapper keeper. My folder is always such a mess. I even got yelled at for it last evening.
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