Hallo everybody!
I’m coming to the end of the last year of University and I’m here to reflect on what and how I’ve learnt, especially in the last few months thanks to the experience of intercultural exchange. I want to focus my attention on how this experience has changed and improved my attitudes about American culture and improved my language skills.
I must admit that my experience of the exchange was not so long, because I started to speak with the American peer more or less only one month ago. However I think that Skype experience was a very useful way to learn something new, but in particular to have a concrete approach with English language. I am convinced that this should have been the real aim of all five years of university. Clearly, it is necessary also to leave with a good background and to know grammatical rules and so on, but what I mean is that the use of a language in the real life is something different, it is like what we did with Corina and during our conversation lessons on Monday.
Moreover the use of a new means of communication helped to create curiosity; skype is like a telephone conversation and I think that without having a person in front of you, you keep more attention to speak correctly. However there is the possibility that the conversation is a little bit boring, if there is not an equal exchange.
In my case it did not happen, because I must say that American people are very open and they have no problem to speak with someone they have never seen before. This is one of the differences that I noticed between American and Italian people, and I’m sure that the reason is cultural. In fact, American people are more modern and independent than us and they used to do a lot of different experiences, far from their own home too, when they are young. Thanks to the exchange and the following editing of the wiki pages, I developed my interest in knowing how you live in another country, which are the value and what is wrong. For example, at the beginning of the semester we spoke about election system in America and I want to say that it has always a tabù for me! It has been very useful to understand how it works and to touch with my own hands how Americans feel this moment, how much it is important for them, but also for all the other countries in the world. This does not happen in Italy…we are really less patriotic than Americans. Moreover I listened to a lot of discourses of the two major candidates and in this way I improved my English knowledge with some new words, and I realized that I am able to follow a native speaker discourse even thought he speaks about more difficult subjects.
Thanks to the final project, I learnt much about American health care system, whose I ignored the mechanism despite of all the telefilms that there are in Italian television. Editing the wiki page for the final project, I also consolidated the notions I learnt during the first semester, in particular I searched for good and updated information in the net, then I tried to be more concise, but clear as possible.
I’m happy because Corina is a student who I can continue to speak English (and also Italian if she wants) with, through Skype, Facebook or simply mails: she is an enormous “opportunity” for me. Even though the process of learning is still long, I know that this year, or rather this part of the course, has really helped me.

U.S.A.
For many years, politicians and insurance companies could blithely proclaim that the U.S. had the best health care system in the world, but Americans are finding it hard to accept this assertion. The 42.6 million people in the U.S. currently without health insurance are acutely aware that the health care system is not working for everyone, and there is growing recognition that the major problems of rising costs and lack of access constitute a real crisis. Health care in the United States is provided by many separate legal entities. Individuals are offered inpatient and outpatient services by commercial, charitable, or governmental entities. The healthcare system is not fully-publicly funded but is a mix of public and private funding. The services and facilities that American health care system offers are different. “Ambulatory care" refers to health care delivered without a stay in the hospital; most health care in the United States occurs in the outpatient setting. "Home health care services" are generally nursing enterprises, but are usually ordered by physicians. Private sector outpatient medical care is provided by personal primary care physicians (specialists in internal medicine, family medicine, and pediatric medicine), subspecialty physicians (gastroenterologists, cardiologists, or pediatric endocrinologists are examples) or non-physicians (including nurse practitioners and physician assistants). Moreover there are for-profit hospitals, which are usually operated by large private corporations and there are nonprofit hospitals, which may be operated by county governments, state governments, religious orders, or independent nonprofit organizations. Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily they exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. "Surgicenters" are examples of specialty clinics. Hospice services for the terminally ill who are expected to live six months or less are most commonly subsidized by charities and government. Prenatal, family planning, and "dysplasia" clinics are government-funded obstetric and gynecologic specialty clinics respectively, and are usually staffed by nurse practitioners.
The main problems of American health system are linked to uninsured Americans and to the disparities in access to hospitals and emergencies, which are often made because of different ethnic and racial groups. In particular, the reasons of disparity are:
· Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines.
· Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.
· Legal barriers. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.
· Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.
· Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.

ITALY
The extension of universal health care coverage to the whole population is a key characteristic of the Italian health care system. In 1978 was established the Italian National Health Service (NHS), Servizio Sanitario Nazionale that is very decentralized, because of a recent strong policy of devolution, which shifts power to the regions. National legislation from 1992 to 1993 and subsequent reforms have radically transformed the NHS, giving the 20 regions political, administrative, and financial responsibility regarding the provision of health care. The Italian state retains limited supervisory control and continues to have overall responsibility for the NHS to assure uniform and essential levels of health services across the country.
The NHS assures an universal coverage for all citizens, regardless of their social status, and an equal access to essential health care services, which are necessary and appropriate to promoting, maintaining, and restoring health in the population (universalism). Essential health services are provided free of charge, or at a minimal charge, and include general medical and pediatric services; essential drugs and those for chronic diseases; treatments administered during hospitalization; rehabilitation and long-term postacute inpatient care; instrument and laboratory diagnostics, as well as other specialized services for early diagnosis and prevention. Finally, the NHS guarantees that the system is subject to popular democratic control at the national, regional, and local level (participation).
The Italian NHS is structured into three different levels of public authority: the central government, the regions, and the local health care agencies (LHAs)—Agenzie Sanitarie Locali, which form the basic elements of the Italian NHS. Based on criteria of efficiency and cost–quality, the LHAs might provide care either directly, through their own facilities (directly managed hospitals and territorial services), or by paying for the services delivered by providers accredited by the regions, such as independent public structures (hospital agencies and university-managed hospitals) and private structures (hospitals, nursing homes, and laboratories under contract to the NHS). Patients can freely choose among the public or accredited private providers. They can also choose to be treated either in the LHA in the area where they reside or in another LHA. Moreover, the Italian NHS provides free primary care, hospital care and community health and hygiene, including diagnosis, treatment, and rehabilitation, as well as prevention, health promotion and educational activities. Primary health care is provided mainly by general practitioners (GPs) and pediatricians, and on-call physicians (Guardia Medica) for afterhours medical care and services. All of these professionals work within the LHA districts, which also include home care and pharmacies.

COMPARISON USA-ITALY:
The U.S. spends more on health care than any other nation in the world. According to the Institute of Medicine of the National Academy of Sciences, the U.S. is the only wealthy, industrialized nation that does not have a universal health care system. In the United States, around 84% of citizens have some form of health insurance; either through their employer (60%), purchased individually (9%), or provided by government programs (27%).
Italy ranks in the middle among European countries in the number of available hospitals and beds, with slightly more than the U.S. The hospital beds in public health facilities are not evenly distributed among Italian regions. Southern regions have fewer than 4.3 beds per 1,000 inhabitants, whereas the northern regions have more than 5.6.14,18 In 1999, the average length of stay was seven days, continuing the downward trend of recent years. Italy has half of the average ratio of personnel per occupied bed of the U.S., which raises questions regarding quality of services and personnel productivity. Italy has the highest density of doctors in Europe, some 350,000, or one for every 163 inhabitants, compared with one for every 400 or so in the United States.
It is possible to evaluate the health care system of a country and especially its organization, that is what citizens can see and use when they need (hospitals and emergency), with respect to some fundamental issues as cost, access to health care and how well health system succeeds in producing good health outcomes in population. The World Health Organisation (WHO) released a report in 2000 and developed three primary goals for what a good health system should do:

Good health: making the health status of the entire population as good as possible across the whole life cycle. As regard this point, you can say that there are many different indicators of the overall health status and well-being of a country’s population, but among the most commonly used measures are infant mortality rates and life expectancy. So, comparing Italy’s and America’s data, you can point out that is no a significant difference: 7,2 infant deaths per 1000 live births in America; 6,8 in Italy.
Responsiveness: responding to people’s expectations of respectful treatment and client orientation by health care providers. In particular, it is important to underline if there is satisfaction with health care system: the U.S. and Italy had the highest level of public discontent. Italy is the lowest among the European Union countries, at 20 percent; U.S. is comparatively low also, with only 40% of people who are satisfied.
For example, from the Italian patient’s point of view, it is not a good service if you go to the hospital and you have to stand in line, if the doctors are arrogant and the quality of service is low. However, for Italian people this would be acceptable, if there won’t be the huge problem of doctors’ mistakes and of the lack of cleanness of hospitals.
Fairness in financing: ensuring financial protection for everyone, with costs distributed according to one’s ability to pay. From this point of view, the two systems are different: Italian health care system is founded on this assertion, even if public money are often used to satisfy private practices of some doctors and not to assure a good service, for example in emergency or to buy necessary machinery. On the other hand, the United States has by far the most expensive health care system in the world.

Italy ranks in the middle among European countries in the number of available hospitals and beds, with slightly more than the U.S. The hospital beds in public health facilities are not evenly distributed among Italian regions. Southern regions have fewer than 4.3 beds per 1,000 inhabitants, whereas the northern regions have more than 5.6.14,18 In 1999, the average length of stay was seven days, continuing the downward trend of recent years. Italy has half of the average ratio of personnel per occupied bed of the U.S., which raises questions regarding quality of services and personnel productivity. Italy has the highest density of doctors in Europe, some 350,000, or one for every 163 inhabitants, compared with one for every 400 or so in the United States.