Italian health care system vs. the US health care system

The Health Care System is a thorny subject in every country of the world: often tied dangerously to the political agendas of its creators, it is known to be one of those matters that could make a government capitulate.

In spite of being both wealthy, developed countries, Italy and the US   have completely different approaches to health care. Italy has a public-based system, supported by the tax income, as well as a flourishing private insurance market which is becoming standard top up to the public "mutua". In America, the public coverage is limited to Medicare, and the private sector is the major provider of health coverage to citizens.


At first glance, moral and logical thought might suggest the Italian system is fairer and should be applied to the U.S. as well. Reality, though,  speaks otherwise:   both systems in fact are based on valid socio-economical factors, but have serious, major flaws.

In Italy, citizens and corporations pay around 50% income tax and are supposed to receive free health coverage from the State. This stands somehow true in case of emergencies , but things get very tricky if you must see a specialist or buy prescription drugs. In that case, there are many variables, which change every year according to new laws, and that can quickly turn free health care into an expense. First of all, if your household has a high income, the benefits are reduced to a minimum - and a 'high income' is considered a salary that exceeds $60,000; this is not really a high figure in today's world and certainly an easy way out for the Italian government to escape its "health" responsibilities. Another down side is the exceedingly long waiting list for hospitals and regular visits in the public system, which might become a serious issue if someone needs surgery. Clearly, in a life or death situation the space is usually found, but the quality of the hospital available may not be the best.

For this reason those Italians that can afford it end up paying for a private insurance, just like in the U.S., while continuing to pay for the public health care through taxes. The bottom line is they pay twice the price for low quality service; the good doctors and the good hospitals must be paid out of one's pocket if patients want access without standing in line.

However, medical expenses in the U.S. are about two or more times as high as in European countries. This is due to a rather aggressive policy, typical of the U.S. Health System,  where doctors perform extensive tests all the time, as well as to the extremely high cost of doctor visits and medical procedures. Basically, since insurance companies pay directly, and patients who have insurance do not have to worry about payment, people do not look around for the best deal, but let the insurance companies cover the cost. This allows doctors and medical centers to present higher bills than average.

In the U.S private insurance is often the only way to get coverage, and it is expensive. Many people forgo it in favor of a bigger car or satellite TV channels. However, the truth is that if balanced in the family budget, insurance is not that bad and will lead to a great health system. Some states like Massachusetts actually cover a lot, and offer Medicare to many without insurance. Medicare at federal level is limited, but still works for certain  socio-economical groups. Most companies provide health coverage, so employees usually get their insurance through their jobs. The American system often fails to cover the lower middle class that doesn't recognize the importance of being covered. This is about 40,000,000 people, equivalent to 2/3 of the entire Italian population. Such numbers emphasize how a comparison between the two countries is, indeed, a hard and complex one to make.

Both systems have problems and, at the same time, both work equally well. Looking at life expectancy, which in Italy is slightly higher (80.5 vs 78.2 according to Wikipedia ), and other easily comparable, unbiased data like the death of women during childbirth (in the U.S. this is 16 for every 100,000 births and in Italy only 4 deaths for every 100,000), offers indications that both systems work in the bigger picture compared to some other countries where life expectancy can be 50 years or less, deaths during childbirth can be as high as 1600 per 100.000.  (The small differences between the U.S and Italy is most probably due to varied health factors).

As in many other life scenarios, it really seems the truth stands in the middle, that is, in a system where both social and private health care find ways to guarantee total coverage. The only certainty is that every human being has the right to proper health care. Each country must find a way to do this well, and keep their populations healthy.



Monday, July 18TH, 2011 by Guest

If I could afford for health insurance, it would far exceed the monthly payment of a luxury car.

Wednesday, July 20TH, 2011 by Guest

There seems to be a lot of generalization here about the Italian health system. I do not know anyone who pays for private insurance on their own here. Some Italian employers offer a back up private health insurance but in my case, this does not cover x-rays, lab tests, or other medical tests.  That said, tests cost very little on the public system. Depending on where you live in Italy, waiting lists vary. There is also the bollino verde which a physician can affix to a prescription or referral for medical testing or a specialist visit that gives the patient priority in scheduling appointments that take as little as 3 to 7 days to arrange (xrays, ekg's,mri's, cat scans or other procedures). I do not remember paying any hospital bills when I gave birth to my children. All children's immunizations were free (and the optional ones were very reasonably priced). All pediatric services are free, I call up my pediatrician and get an appointment usually on the same day. Both my children get free allergy testing and consultations every year and free prescription medication (antibiotics, allergy inhalers, etc.). When one child was hospitalized twice and I spent the night with her, the only bill I had to pay was for my meals. My prescriptions are practically free. I can visit my doctor  when ever I need to (in my case, my physician does not give appointments, she is available M-F from 830-1030 and 430-7pm, just show up and wait your turn which is pretty democratic.) IompI have also had free pediatric and gp house calls! In the States where I worked for a private elementary school, I had no insurance, I earned less then a year's tuitition, room and board at my undergraduate college, and when I got sick I showed up at the reduced income clinic (I looked and felt out of place, I was employed but too poor to buy health insurance, pay back my college loans or pay for a private doctor.). Now dental coverage is another ball game.

Saturday, July 30TH, 2011 by Guest

This article reads like a 5th grade research paper full of generalizations with little reference to hard facts.  That said, I'm not going to bother quoting hard facts either or doing any actual research, other than to say that the majority of US bankruptcies are due to medical bills incurred by families that HAD insurance.  Health insurance in the US is like a 10 foot rope for people stuck in a 20 foot hole.  The only financial benefit to health insurance is the insurance company's contracted rate with the providers.  But even when a problem comes up the insured usually ends up paying more in premiums, deductables, coinsurance, copays, and uncovered expenses than if they could have just paid the physicians directly the provider's CONTRACTED rate.  Most billing problems come when provider's try to stick "list price" to private payers.  List price can be $35k even though they contract with insurance companies to be paid only $600.00 for an identical procedure.  Insurance companies in the US deny claims in order to turn a profit so people who paid for their insurance usually don't get what they need when they really need it.  For instance, 10 days inpatient care won't save you from bankruptcy if your condition requires 30-40 days in-patient.  And yet those 10 days at the contracted rate doesn't even cost the insurance company more than what a consumer will pay in premiums after the consumer has met their copy, coinsurance, and deductable.  US health insurance by design is a defective product.  Families with insurance who really need expensive care almost always end up destitute, bankrupt, on medicaid, divorced, and miserable until the patient is cured, dead, or turns 18.

Wednesday, November 07TH, 2012 by Guest

You better "do your homework" before you talk about things you clearly don't know. Italian healthcare doesn't work like that. It's much better.

Tuesday, May 21TH, 2013 by Guest