Saturday, March 23, 2019


drawing by Suzanne Dunaway
Italy’s fashion and restaurants belong in the First World, its bureaucracy in what was once called the Second World, its garbage collection—at least in Rome—squarely in the Third. In healthcare the dominant model is mixed: free but slightly shabby health care for all, and a private sector providing a luxury dusting of sugar on top.
A private doc is expected to hear you out, sift through your records, lay on hands, assign a diagnostic label, and prescribe a pageful of remedies. In short, enhance not just your health but your self-worth. At your National Health Service GP’s office you may stand in the hall two hours marking time; in a private waiting room you’ll be leafing through art books in a Le Corbusier chair.
I’ve had feet in both tracks of the system: the underfunded public side for doing research, and the flush private world for seeing patients. I caught on fast that being a leftist wouldn’t save me from the siren call of private medicine’s petty corruptions. When business is slow, economic self-interest can nudge you to bring the patient back in two weeks rather than four and to do an ECG that in a busier moment you might have skipped. When the schedule is packed you can be tempted to start cutting corners in your thoroughness, vigilance, and attention to detail. And however much you despise yourself for it, you treat Very Important Patients with kid gloves.
Private medicine has always been bigger in southern Italy than in the North, where the public system works. Back in the 1980s, the golden days of free spending, people would check into Rome’s private hospitals or cliniche for week-long tune-ups. Those posh wards were packed with healthy, wealthy Romans enjoying prods, needle sticks, and x-rays. Italian private medicine began to suffer in the 1990s, when the Clean Hands political corruption investigation shriveled the supply of illicit cash. Since then, the cliniche have struggled to fill their beds. Even if there weren’t a perennial economic crisis, there’s Europe and a steadily improving Italian National Health Service: why should you pay to stay in a private hospital when you can have world-class surgery at a public one, here or elsewhere in the European Union, for free?
Some private hospitals have fought back by making deals with the National Health Service, so public funds will cover the room and the operating suite while the patient pays the surgeon and the anesthesiologist.
Others keep afloat by stiffing their medical staff. Squeezed by an economic climate that leaves half their beds empty but eager to improve their competitive edge, some of Rome’s cliniche have plunged ahead with expensive renovation schemes despite a shortfall in ready cash, making up the difference by pocketing the money sent by insurance companies to cover doctors’ fees. At this moment I’ve been waiting a year and a half to get €550 for one patient’s brief hospitalization; a surgeon friend claims he’s owed €150,000.
But then nearly everybody scrambles to cobble together a living here, though watching the elegant figures parade down Rome streets you’d never know it. While I was building up my practice, funding my office rent by doing medical translations, I used to wait eight or ten months to be paid; my tax refund for 1987 came through in 1992. My musician husband may get his concert fee the same night, a year later, or never. Even a permanent full-time civil service job can’t be counted on for a steady income if, as I write, one of the public hospital docs in my office hasn’t been paid for six months. Thank heavens for the long-suffering Italian family, a surefire backup system guaranteed to ward off starvation.
(a version of this post has been published in my Bedside Manners column, at The American: In Italia)
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