Italy has a universal health care system publicly funded through taxes called Servizio Sanitario Nazionale (S.S.N.) which is organized under the Ministry of Health and is administered on a regional basis. It was founded in 1978. Some people prefer to take private health insurance cover over and above the basic state cover. With private insurance, you can freely choose your own doctor and specialist and be treated at private hospitals, thus avoiding long queues to get an appointment for a medical specialist.

What happens if you need to see a doctor?
Family doctors (GPs) are entirely paid by the SSN, and they are required to offer visiting times at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subject to availability. Prescription drugs can be acquired if prescribed by a doctor. If prescribed by the family doctor, the prescriptions are generally subsidized, requiring a small fee (copay) that depends on the medicine type and on the patient income. In many regions all the prescribed drugs are free for the poor.

People with type 1 diabetes are exempt from paying any prescription charges. Over-the-counter drugs are paid out-of-pocket. Both prescription and over-the-counter drugs can only be bought and sold in pharmacies. Visits to specialist doctors and diagnostic tests are provided by the public hospitals or by approved private ones. If you are referred to a specialist or to have tests done which are prescribed by the family doctor, they require only a copay (for example, $40 for a specialist visit without any diagnostic test) and are free for the poor. Waiting times are usually up to a few months in the big public facilities and up to a few weeks in the small private facilities. Patients can opt for the "free market" option, provided by both public and private hospitals, which is paid completely out-of-pocket and has generally much shorter waiting times.

Who decides what medicines a doctor can prescribe?
The European Medicines Agency (EMA) is responsible for the scientific evaluation, supervision and safety monitoring of medicines developed by pharmaceutical companies for use in the EU. The Italian Medicines Agency (AIFA) is the national authority responsible for drugs regulation in Italy. It is a public body operating autonomously, transparently and according to cost-effectiveness criteria, under the direction of the Ministry of Health and under the vigilance of the Ministry of Health and the Ministry of Economy.

Practically, what is it like to live with type 1 diabetes in Italy?
All diabetic medicines, supplies and devices like insulin, glucagon, glucometers, blood sugar test strips, urine test strips, pumps, sensors and so on are completely free to every patient with type 1 diabetes. Medicines (like insulin) are usually prescribed by your GP, and supplies (e.g. test strips) are normally prescribed by your endocrinologist/diabetes specialist. Patients with type 1 diabetes are always referred to see an endocrinologist every 3-4 months for free. In addition, in every diabetic clinic patients should have access to diabetes specialist nurses, dieticians and a psychologists.

What about getting admitted to hospital?
Emergency medical service is always free of charge. First aid is provided by all the public hospitals. For urgent cases it is completely free of charge for everyone (even for the undocumented), while a copay (about $35) is sometimes asked for non-urgent cases.

How does diabetes care vary throughout the country?
Diabetes care varies a lot across Italy, especially because Health Care is administered on a regional basis. Everyone is allowed to receive insulin for free but, for instance, not everyone is able to get an insulin pump or a continuous glucose monitor. Moreover, test strips are often limited by doctors who can't prescribe more than 200 strips per month most of the time.

Thanks to our friend Alessandro Cecconi in Italy for helping us with this information.