16 March 2007

Enrolling in the Italian health system

As of today we are officially enrolled in the Italian national healthcare system known as Servizio Sanitario Nazionale (SSN). Here in Marche the SSN system goes by the acronym of ASUR. Joining the system presented another batch of bureaucratic issues for us to weave through and, as has become the norm, it involved multiple visits to the ufficio in question.

The heath system is paid for by taxes levied against employers; if you are not employed, it is by a fee you pay. If you are employed you just take a copy of your work contract and some identification documents and you are all set with coverage for you and your family. If you are a student you pay a fee of less than 200 Euro. For those of us who don’t fall into those two categories and have spouses (or children) it gets confusing.

When we applied for our residenza (which is still pending more paperwork) they gave us a receipt in my name and said we could use it to apply at the ASUR office along with a form declaring dependants, “dichiarazioni sostitutive di certificazioni”. The majority of the information available on the internet deals with employees and students, leaving those not in those categories guessing. Everyone seemed to agree that you need the receipt for the residenza, your permesso di soggiorno, your codice fiscal (tax id) and pay a fee. No one mentioned the dichiarazioni sostitutive di certificazioni. The fee is 387.34 Euro, but the question is do you pay this once as a family or does each person in the family pay the fee? For that question we found a lot of conflicting information.

Two weeks ago Valerie and I went to the ASUR office which is just up the hill from our apartment, taking our documents. We thought we were all set to sign-up. Not so fast, the man at the window had to go ask someone else what we were supposed to pay and came back with two forms we needed to take to the bank and pay the 387.34 Euro for each of us – over $1000 for the two of us for the rest of 2007. Since we had conflicting reports if both had to pay or I could sign-up and list Valerie as a dependant, I finally decided to try and pay one fee and roll the dice.

Thursday I went to the bank and paid the fee and then trudged back up to the office and waited in line. Eventually when it was my turn, using my broken Italian I was able to provide the clerk with my receipt for residenza, codice fiscale, passport, permesso di saggiorno, receipt for the 387.34 Euro and the completed dichiarazioni form which stated Valerie as my dependent. The clerk had copies made of everything, asked what doctor I would want as my primary care provider, and then told me to come back the next day. Apparently she was in a hurry for another caffé as she put up her chuiso sign as I walked away.

Today I went back up the hill and there was a different clerk at the required window; again in my broken Italian I explained that the other clerk told me to come back today, he asked my name and cringed when I said “Schneider” as he tried to pronounce it. He retreated to the back office and came back with the copies of my documents and then had to input everything as I stood and watched. When finished, he printed a short receipt which he had me sign and gave to me and, if I understood correctly, said I should expect an official card in the mail in about ten days.

So after three trips to the same office and a trip to the bank, I have my receipt showing our enrollment in the Italian national healthcare system. Hopefully this is not something we will need to take advantage of any time soon.


Anonymous said...

An interesting account of dealing with the bureaucracy. It might also be interesting to investigate how being able to buy health insurance for two persons for $500 per year effects families: i.e. economically and socially and also to hear the decision making process you used in choosing your primary care physician. The only news one hears in USA is how awful all socialized medecine systems are. How is it in Italy?
P.S. An Italian friend of mine looked at your blog and remarked: He's a guest in our country and fortunate to be allowed to take part in our system.

Bryan said...

I have only heard positive personal acounts of actual health care here, despite the regular news stories of poor management of the system.
The price is a bargain; our frustration is that the people who run the system don't even seem to know what the process is.

Brendan said...

I have had 2 operations and I must say I was more than satisfied with the Italian medical care. As a US native, I was quite impressed with being able to leave the hospital after surgery and not being asked for a dime (only a signature saying I was fit to leave) or being harassed for an insurance policy number.

The only difference is the "do it yourself" and bureaucracy factor. You need to go to different clinics to get different tests done and you are expected to pick up the results. Ha, of course the waiting in lines at Italian clinics in itself can cause the need for emergency medical care!

Bryan said...

Brendan, I have heard nothing but positive comments from people who have had tx here.

Anonymous said...

It is a given that Italian bureaucracy is challenging. We all should have accepted that when we CHOSE to become resident in Italy. The extraordinary generosity of the Italian healthcare system which allows "elective residents" to participate for such a preposterously small amount of money more than compensates for any standing in line. It also is appropriate for someone who chooses to live in Italy and participate in the benefits of Italian residency to study the language--it is quite possible that some of the responsibility for confusion rests with the non-Italian speaking party.

Furthermore, compare the effort and the result in Italy to dealing with U.S. health insurance companies whose policy is to deny claims when the are first presented in the hope that people who have been paying huge amounts of money in insurance will just give up.

Bryan said...

"anonymous" - I agree the health care system here for us "elective residents" is a good system. Fortunatley we have not had to test this so far.

"Furthermore, compare the effort and the result in Italy to dealing with U.S. health insurance companies whose policy is to deny claims when the are first presented in the hope that people who have been paying huge amounts of money in insurance will just give up." -
Sounds like someone has a bone to pick but this is not the proper place. My blog is about my insights and experiences in living in Italy.