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When I moved to Italy two years ago, I didn’t have plans to sign up for the national health service, as I’d been warned about a universal truth of any bureaucratic process there: One task always seems to beget another.
But the first time I got sick, the choice no longer felt voluntary. On the precipice of losing my voice, I called various doctors, all the while taking sips from my mug of tea, hoping to secure an appointment for sometime that week. What I didn’t understand — and what each office promptly explained to me — was that, without a tessera sanitaria, or a health card, they couldn’t see me. Patients were assigned in the system, and for the average medico di base, or general practitioner, this was done through the Azienda Sanitaria Locale, local administrative health offices.
So, at a certain point, the choice was made for me. Did I want access to a health care system that would likely be more comprehensive, accessible, and certainly less expensive than what I was used to in the United States? Or did I want to use the network of English-speaking doctors in Rome that were either private or catered largely to tourists, and with whom it would be difficult to develop a long-standing relationship? Framed in these terms, the question no longer seemed hard to answer.
As a student in Italy, I was not able to automatically enroll for free in the health system. For years students had paid a set fee of 149 euro to “voluntarily sign up” for the health service, but this year, due to new budgetary legislation, student fees were raised to 700 euro for a yearlong subscription.
Still, when compared with the average annual cost of health insurance in the United States, which clocked in at $8,951 for individual coverage in 2024, this felt, literally, like a small price to pay. This figure also refers only to covered workers, meaning those who receive employer-sponsored health insurance, per the Kaiser Family Foundation (KFF).
Over the past 24 years, the cost of individual health insurance in the US has gone up almost fourfold: from $2,196 in 1999 to $8,951 in 2024. These surging costs are evidenced by the difficulty the average American has in paying for health insurance: Roughly half of US adults find it challenging to pay for coverage, per KFF data from 2024, while one in four adults said they had skipped or postponed necessary health care in the past year due to costs; roughly 21% of adults also said they did not fill a prescription because of the price.
My experiences in Italy have been vastly different. I haven’t had a major health problem, but I have been able to easily get prescriptions and ask for medical advice when needed. When I call to make an appointment with my local doctor, I simply tell them my name and ask for the first available slot. Perhaps more importantly, I now value the relationship I have with my doctor, who always seems to remember me and asks how I’m doing (though the fact that I’m American surely helps me stand out).
