I had to take a break from translating this morning in order to find out what documents I needed, if any, to renew what in Italian is called an esenzione, that is, an exemption from paying a small fee, called ticket (no really, that is what it is called; it is pronounced “teekit”) for tests, hospital care, prescription medicines and so on.

Since I don’t have much time to explain all this in my own words, I will copy and paste part of a paragraph from Wikipedia that gives the gist of how the Italian healthcare system works (as a cancer patient, I belong to one of the below-mentioned “various categories” that are exempt from all healthcare-related payments):

According to WHO in 2000, Italy had the world’s “second overall best” healthcare system in the world, coming after France, and surpassing Spain, Oman and Japan. In 1978 Italy adopted a tax-funded universal health care system called “National Health Service” (in Italian: Servizio Sanitario Nazionale), which was closely modeled on the British system. The SSN covers general practice (distinct between adult and pediatric practice), outpatient and inpatient treatments, and the cost of most (but not all) drugs and sanitary ware.  The government sets LEA (fundamental levels of care, Livelli essenziali di assistenza in Italian) which cover all necessary treatments, which the state must guarantee to all for free or for a “ticket”, a share of the costs (but various categories are exempted). You can read more here: http://goo.gl/63vMZ

In February of 2006, that is, after my MGUS became MM (on paper, you see, there is no distinction between MM and SMM, so I am officially a MM patient here), I applied for, and was granted, a healthcare exemption, which lasts for five years. This has meant that for the past five years I haven’t paid one cent for any prescription drugs (antibiotics, e.g.) or for any blood/urine/other tests. When I was still MGUS, though, like all healthy Italians and residents of Italy, I paid a “teekit.” I think the most I ever paid was more or less 100 euros (= about $ 130), for my bone marrow biopsy in 2005. Of course, given the choice, I would rather pay the healthcare “teekit,” since that would mean I don’t have cancer anymore…!

Okay, back to us. Yesterday I phoned my local health office, = ASL, to see if someone could tell me what steps I needed to take to renew my exemption. “Ah, signora, I have no idea. You must call back tomorrow morning,” I was told by a very nice but not very helpful man. So I called back this morning and was told the following: “Ah, signora, you must come here yourself and go to this-that-and-everything healthcare office.” “Can’t you tell me over the phone or find someone who can?” I asked. “No, sorry.” Okay. Fine. I grabbed all my health-related documents and went over to the ASL office.

A helpful woman in the this-that-and-everything healthcare office told me that I cannot renew my exemption until after it expires…next month. The day after it expires, apparently all I have to do is show up at the front desk of the ASL, and my exemption will be automatically renewed…

I don’t have to show any proof that I still have cancer. I don’t need another BMB. I don’t have to be seen by an ASL doctor. No. This will be easy peasy.

The first renewal, which will give me another 5 years, is automatic, I was told. But my second renewal, five years from now, will not be so easy: I will have to make an appointment with an oncologist, blablabla. I found this rather interesting from a psychological point of view. Could it be that if you have myeloma for more than 10 years, they think you might be faking it? Hmmm. No idea. In fact, perhaps all types of cancer are treated the same way. I should have asked…but it didn’t occur to me at the time. Well, all I can say is that I am relieved to know that it won’t be too much of a drag to get this thing renewed…

Now, before I go on to my final considerations, please don’t get me wrong. I love living here. Indeed, I cannot really see myself living anywhere else, except perhaps in Canada or Massachusetts or Vermont. I don’t mind the occasional Italian bureaucracy absurdities…I grew up here, after all, so I am used to them. And in fact I was chuckling as I left the ASL office…

But really, on second thought…Couldn’t the simple information about my exemption have been given to me over the phone? Was it really necessary for me to go over to the ASL office? Now, I am not complaining about the time I wasted, since I can work on my own schedule…But what about people with jobs? Why make them take time off work just to let them know that they will have to come back later…taking more time off?

Makes no sense.

But that is the way things are here…sometimes. You need a good dose of pazienza…sometimes. But hey, it’s an incredibly small price to pay for living in a lovely country whose healthcare system ranks “second overall best” in the world (World Health Organization, 2000). And there are many other perks, too! 🙂