Italy’s national health care is rated second in the world by the WHO.  However, a closer look will show that there is trouble plaguing this system from a crippling bureaucracy, mismanagement, general disorganization, spiraling cost, and long waiting lines.

The Italian constitution was changed in 2001 so that the national government now sets the “essential levels of care” and regional governments still control their budgets and resources to the local areas.

• Payroll taxes have a regressive structure starting at 10.6 percent of the first $30,000 of gross income and decreasing to 4.6 percent up to $100,000 gross income.  The remainder of the funding comes from both federal and regional general taxation, including income and value-added taxes.

• In-patient and primary care are free at the point of treatment. However, co-payments are required for diagnostic procedures, specialist, and Rx drugs. The copays run around 30 percent of the services rendered. The elderly, pregnant women and children are exempt from the copays–which is nearly 40 percent of the population.

• Italians have limited choice of physicians.  They must register with a general practitioner within their LHA.  They may choose any GP in the LHA, but may not go outside it except for emergency care.  A referral from a GP is required for diagnostic services, hospitalization, and treatment by a specialist.

• Most physicians are reimbursed on a capitated basis, which is based on the number of patients served over a given time period rather than the services actually provided. Some hospital physicians receive a monthly salary.

• Private health insurance is available in Italy but is not widespread. About 10 percent of Italians have private insurance, and the low percentage is due that one cannot opt out of the national care system.

• Waiting periods on average for medical care:  70 days for a mammogram, 74 days for endoscopies, and 23 days for a sonogram.  This is due to shortage of modern medical technology.

• The US has two times as many MRI units per million people and 25 percent more CT scanners.

• Introduction of many of the newest and most innovative Rx drugs have been blocked by the Italian government to control Rx cost.

• Conditions in public hospitals are considered substandard, particularly in the south.

• Dissatisfaction with the Italian health care system is extremely high, by some measures the highest in Europe.  Fifty-five percent of Italians believe that it should be easier for patients to spend their own money on health care.

Italy is the 4th most visited country in the world. Before you travel, know these important travel tips for Italy:

• In an emergency, dial 113 – Italy’s equivalent to our 911
• The best months for visiting Italy are April-May and October
• Avoid Rome and Venice in July and August – the Triple H: too humid, too hot, too many humans
• Women should consider not sightseeing with a purse – put the money in your pocket, and keep the hair brush and lipstick back at the hotel
• Gelatto ice cream cones are a must – plan on gaining weight
• Using hand-held cellular phones while driving is prohibited
• If your car breaks down, dial 116 for breakdown service
• If invited to someone’s home, the traditional gift is a tray of sweets from a pastry shop.

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Cecile Richards, president of Planned Parenthood Federation of America, discusses the Bush administrations midnight regulation, which will undermine health care access at nearly 600000 health care centers, pharmacies, and hospitals across the country. To take action, visit www.ppaction.org

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