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HEALTH

OPINION: Italian healthcare is stuck in the past – but now it has a chance to modernise

The move to digital prescriptions was one positive to come out of the pandemic in Italy, but this could soon be reversed - despite the urgent need for more reform, says Silvia Marchetti.

OPINION: Italian healthcare is stuck in the past - but now it has a chance to modernise
Paper prescriptions were the only option in Italy until the Covid pandemic. (Photo by Tiziana FABI / AFP)

At the end of 2022, Italy’s government approved a one-year extension of electronic prescription for medicines, but it is just temporary and there’s a high risk it might disappear in 2024.

The e-prescription should be made a permanent measure, alongside other urgent improvements in the Italian healthcare system that’s in need of modernization.

In recent weeks, doctors and patients held their breath as political parties debated the fate of digital prescription slips. Until the very end, it looked like the digital ricetta medica was going to be shelved, reverting in January to the pre-Covid paper slips and the nuisance of going to the doctor to fetch it.

The e-prescription has been one of the few positive outcomes of the pandemic. It proved a godsend for both general practitioners (medici di base) and patients during the Covid emergency, when social distancing was the norm and crowding at the doctor’s office was the best way to pass on bacteria and viruses.

Many Italians turned to the digital ricetta during lockdown, even those who’d normally queue up regularly at the doctor’s just to grab their prescription and go to the pharmacy.

READ ALSO: Five essential facts about Italy’s public healthcare system  

The ricetta elettronica also spares a lot of paper waste and precious time, allowing people to go shopping or to the gym instead of waiting hours in line. It has helped to boost the digitalization of Italian health care.

Before Covid, even patients with chronic diseases who needed a monthly prescription had to knock at their doctors’ door.

If next year there is no radical reform that makes digital ricetta the rule and a structural measure, it would be a major step back. 

Photo by Marco BERTORELLO / AFP

The truth is that not all doctors, nor patients (particularly the elderly), are digital savvy. Many doctors I know still prefer to write by hand the paper prescriptions with their personal signature.

My medico di base really needs to retire. He is 70 and even though patients call him by phone to order prescriptions he is able to send just some ones via email while others for specific medicines they still have to pick up at his office, getting in line as if they had to be visited. It is a major nuisance.

When I was living in Holland back in 2005 doctors were accustomed to sending digital prescriptions straight to the pharmacy nearest to the patient’s home, who just had to stop by after work. 

Patients with chronic diseases would regularly drop by the pharmacy next door and pick up the monthly prescribed dose. I wish it worked the same way in Italy.

READ ALSO: How bad is Italy’s north-south ‘healthcare gap’ really?

There are many other aspects of healthcare that should be modernised permanently in Italy. 

And this can be done by boosting online centralized services, which citizens could have access to through their fascicolo elettronico sanitario (electronic medical file), which is like their ‘health passport’ where all health information should be stored, from prescribed medicines to allergies, hospitalizations and results of exams. 

The fascicolo was launched with Covid to download test results and green passes, but it has enormous potential. It is linked to a personal tessera sanitaria (the health card), otherwise known also as the codice fiscale (tax identification number).

The electronic fascicolo should allow the booking of medical appointments and exams at public and private hospitals, and the ordering of medicines at your pharmacy that do not need a prescription. An SMS could be sent to alert patients when medicines and exam results are ready.

Much-needed healthcare improvements also include more efficient online bookings of doctors’ appointments, check-ups and exams. Many hospitals and clinics have online platforms for private booking, but these seldom work well due to internet glitches so patients have to revert to call centers which are always busy, leave their number and hope to be called back. Online platforms are also useful if one has to cancel an appointment.

READ ALSO: Who can register for national healthcare in Italy?

There should be online tickets for blood tests at medical labs and hospitals, downloadable on smartphones with a precise time. It’s crazy that people need to queue up early in the morning, without breakfast, just to take the bigliettino (ticket with their number) and wait to be called by the nurse for the blood test.

In Italy everyone knows that national healthcare waiting lists for surgeries, exams and day procedures can be months-long, but private facilities, where patients are willing and can afford to pay, cannot be as slow as the public sector. I remember once having to book an emergency private allergy test by phone and finding out I had to wait four months, despite it being at one of the biggest hospitals in Rome. 

Private appointments at public hospitals, which can cost up to €300, need to implement faster appointment procedures and boost the number of available doctors.

Italian public healthcare is one of the most democratic in the world, willing to treat anyone in need for free. But when it comes to modernisation, there are many challenges yet to overcome.

Member comments

  1. My doctor does use electronic prescriptions sent to the pharmacy, but then I need to go to the pharmacy to show my copy so they can order. the medication as the government does not allow them to keep a stock. Admittedly it’s not a standard medication but you would think the pharmacy could place the order without my confirmation .

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HEALTH

Living in Italy: Five tips to help you survive the local pharmacy

From ear piercings to flu jabs, Italian ‘farmacie’ are among the most useful stores in the country, but they’re also very odd places. Here are our tips on getting through the pharmacy experience.

Living in Italy: Five tips to help you survive the local pharmacy

Italian pharmacies aren’t just stores selling prescription or over-the-counter medicines.

As a customer, you’ll find all sorts of natural remedies, basic health supplies and personal care items on their shelves. 

You’ll also be able to receive basic medical services (for instance, blood pressure checks, Covid tests and flu jabs) and some non-health-related ones (like getting your ears pierced!) in most branches. 

READ ALSO: Reader question: Can I still get the flu vaccine in Italy? 

But, while being extremely useful stores, Italian farmacie (pronunciation available here) are also peculiar places and their set of unwritten rules and solidified traditions may well throw off newcomers.. 

So here are five tips that might help you complete your first expeditions to your local pharmacy without making a fool of yourself.

1 – Decipher your doctor’s scribbles before your trip

Much like some of their foreign colleagues, Italian GPs have a penchant for writing prescriptions that no one else is actually able to read. 

We might never find out why doctors seem so intent on making ancient hieroglyphs fashionable again, but their calligraphic efforts will surely get in the way of you trying to buy whatever medicine you need to survive. 

To avoid hiccups, make sure you know exactly what you need to get. If in doubt, reach out to your GP to confirm.

Don’t rely on pharmacists being able to figure out your doctor’s handwriting because they often have no clue either.

READ ALSO: EXPLAINED: How to make a doctor’s appointment in Italy 

Pharmacy in Codogno, near Milan

In most small towns and rural areas local pharmacies have very ‘thin’ opening hours. Photo by Miguel MEDINA / AFP

2 – Double-check the pharmacy’s opening times

If you’re from the UK or the US, you might be used to pharmacies being open from 8am to 10pm on weekdays and having slightly reduced opening times over the weekend. 

You can forget about that in Italy. In big cities, most pharmacies will shut no later than 8pm on weekdays and will be closed on either Saturdays or Sundays.

READ ALSO: Coughs, colds and flu: What to say and do if you fall sick in Italy 

As for small towns or villages, opening times will have a nice Middle Ages vibe to them, with local stores remaining shut on weekends and keeping their doors open from 9am to 12.30pm and then from 3.30pm to 7.30pm on weekdays. 

So always check your local pharmacy’s hours before leaving home and, should their times not be available online, call them up. An awkward phone conversation with the pharmacist is still preferable to a wasted trip.

3 – Get the ‘numerino

Some Italian pharmacies have a ticket-dispensing machine with the aim of regulating the queue – a concept which is still foreign to many across the country.

All customers are expected to get a numbered paper ticket (the famed ‘numerino’) from the above machine and wait for their number to be called to walk up to the pharmacist’s desk. 

Now, the law of the land categorically prohibits customers from getting within a five-metre radius of the desk without a numerino

Also, trying to break that rule may result in a number of disdainful sideways glances from local customers.

4 – You cannot escape the in-store conversations, so embrace them 

Pharmacies aren’t just stores. They’re a cornerstone of Italian life and locals do a good deal of socialising on the premises. 

After all, the waiting times are often a bit dispiriting, so how can you blame them for killing the time?

Small pharmacy in Italy

Pharmacies are an essential part of Italian life and culture. Photo by Marco SABADIN / AFP

You might think that locals won’t want to talk to you because you’re a foreigner or don’t know the language too well, but you’ll marvel at how chatty some are.

While chit-chat might not be your cup of tea, talking with locals might help you improve your Italian, so it’s worth a shot.

5 – “Vuoi scaricarlo?”

The pharmacist finally gets you what you need and you’re now thinking that your mission is over. Well, not yet.

Before charging you for the items in question, the pharmacist will ask you whether you’d like to ‘scaricarli’ (literally, ‘offload them’) or not, which, no matter how good your Italian is, will not make any sense to you.

What the pharmacist is actually asking you is whether you want to link the purchase to your codice fiscale (tax code). 

READ ALSO: Codice fiscale: How to get your Italian tax code (and why you need one)   

That’s because Italy offers residents a 19-percent discount on some health-related expenses, which can be claimed through one’s annual income declaration (dichiarazione dei redditi) by attaching the receipts of all the eligible payments.

Whether you want to scaricare or not, this is the last obstacle before you can make your way back home.

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