Thinking of travelling to Italy for treatment? I would think again

In my experience there are two different Italian health systems. If you get hit by a scooter, or (as happened to our son) get kicked in the jaw by a mate and bite a hole in your tongue, you rush to the nearest hospital with an Emergency (Pronto Soccorso) department.

There is often a substantial wait in dingy, comfortless surroundings, but no questions are asked beyond name and address, no payment demanded, and the treatment when it comes is brisk, informal yet highly competent. They deal with patients straightforwardly: "Either he can stay in overnight, have an aesthetic and we'll do it in the morning," the doctor explained about Gabriel's tongue, "or we can put the stitches in right now."

Right now, we said courageously, and it was all over in half an hour. No messing, plenty of adrenaline, and above all (a miracle in Italy) no bureaucracy. And completely free. We could have been from Los Angeles or the backside of Romania and the attitude of the staff would have been the same.

But when the case is not an emergency, there is no urgency and the Italian genius for creating bureaucratic impediments can really get going. I broke a wrist in London and had it set in plaster there, but then had to return to our base in Rome where the plaster would have to be removed, the fracture X-rayed and new plaster applied.

Simple stuff, you would think. But the fact that I had not been referred by an Italian hospital immediately threw the system into a tizzy. Clearly I had a broken wrist, clearly I was in Italy and would need it seeing to but without that Italian reference I was in limbo.

Several bitter conversations later, at high volume and with much waving of hands, someone was prevailed upon to give me an appointment. But in contrast to Pronto Soccorso, the whole outpatients' department had a seedy, corrupt air about it. The X-ray technicians went about their work sighing with boredom, the consultant could barely disguise the ennui my case induced, and got rid of me as fast was decent, or a little faster. Every subsequent appointment had to be approved and processed by the equivalent of the local GP. And every visit I was required to pay tens of euros.