Understanding the “Celiac Discount” in Italy
If you’ve ever spent any time browsing Facebook groups for celiacs, you’ve heard how green with envy the American celiacs are over Italian celiacs receiving a monthly stipend for gluten free food. Well, the rumors are true. Italy does offer financial support for those diagnosed with celiac disease to offset the elevated prices of gluten free food. But it’s not as easy as declaring to the cashier at the grocery store that you have celiac disease and viola…free food! So how exactly does it work? And how much money are Italian celiacs actually receiving from the government? In this article, we’ll take a deep dive into the Italian “celiac discount.”
The stipend in question, usually referred to as the “bonus celiachia” or “buono mensile” in Italian, was introduced in the 1980s to help offset the increased prices of gluten free food for those diagnosed with celiac disease (and therefore medically required to maintain a strict gluten free diet). The support is provided by the Servizio Sanitario Nazionale (National Health Service) and is available only to Italian residents who are registered in this public health care system. So no, celiac tourists who are just visiting can’t take advantage of this discount.
The other catch? It is necessary to either be diagnosed in Italy or get a foreign diagnosis certified by an Italian doctor. This has created quite a barrier to entry for foreign celiacs to take advantage of the service. There is so much red tape and hoop-jumping involved in this process for a foreigner that I, an American celiac who has been a legal Italian resident for years (but was diagnosed in the States), still don’t have access to the bonus celiachia. Unless you can find an Italian doctor who is willing to “sign off” on your foreign diagnosis, you would more than likely have to go through the entire diagnosis process again. You heard that right…the gluten challenge, the endoscopy, the whole kit and caboodle. And if you ask me, a small discount on my groceries is not worth the physical trauma of going through diagnosis again.
The actual amount celiacs receive is dependent on our age and, unfortunately, our gender. The amount is calculated based on the Livelli di Assunzione di Riferimento di Nutrienti ed energia (LARN) (Reference Intake Levels of Nutrients and Energy, in English), which is essentially a standardized guideline for how many calories men and women of different ages require to maintain a healthy weight. Italy still operates with the dated mentality that women require fewer calories than men and, therefore, men receive more money. Archaic? You bet! They’re estimating that 15% of our daily caloric intake fits into the protein category, 30% into total fat, and 55% into total carbohydrates of which 20% are naturally gluten free and the remaining 35% is what the stipend covers. Check out this graphic from the Associazione Italiana Celiachia (Italian Celiac Association) if you’re more of a visual learner:
Here’s a breakdown of the monthly stipend by age and gender:
Once an Italian is diagnosed with celiac disease, they must take their certificate of diagnosis to the Azienda Sanitaria Locale (local health authorities) of their region to have it verified and receive the stipend. Every region is different…some regions give physical cards that are pre-loaded with the stipend and some just write it on paper like a prescription which can be redeemed in conjunction with showing your tessera sanitaria (health insurance card). The stipend can be used in select pharmacies, grocery stores, and specialty gluten free shops across the country. The exact list of what kind of products can be purchased with the buono mensile can be found at the Registro Nazionale Degli Alimenti Senza Glutine (RNA) but, in short, the list includes bread, crackers, pasta, pizza, sweets like cake and cookies, and flour blends. When shopping at a regular supermarket there will usually be a sign on the items that can be purchased with the stipend. For example, this one at my local grocery store says “Product reimbursable by the Tuscan regional health service.”
The stipend expires at the end of the month and does not roll over, so celiacs often rush at the end of the month to stock up and use the rest of their remaining credit. The stipend can also only be spent in the region it is provided by. So if you receive your buono mensile from Tuscany but are visiting Rome and want to buy gluten free products you could not use your stipend. And if you move you have to go through the process again to receive the stipend in your new region.
I think it’s so great that Italy offers this support to celiacs and we’re clearly ahead of the curve in comparison to many other countries. That said, my fingers are crossed that we continue the momentum in this positive direction to make the service more easily available and equitable. It goes without saying that we, as a country, have a long way to go when it comes to gender equality and accessibility for immigrants.
What do you think about Italy offering financial aid to those with celiac disease? Does your country offer financial support for celiacs? Let me know in the comments!