Abstract
With the ageing population, equitable access to medical care has proven to be paramount for the effective and efficient management of all diseases. Healthcare access can be hindered by cost barriers for drugs or exams, long waiting lists or difficult access to the place where the needed healthcare service is provided. The aim of this paper is to investigate whether the probability of facing one of these barriers varies among individuals with different socio-economic status and care needs, controlling for geographical variability. Methods. The sample for this study included 9629 interviews with Italian individuals, aged 15 and over, from the second wave (2015) of the European Health Interview Survey, which was conducted in all EU Member States. To model barriers to healthcare, two-level variance components of logistic regression models with a nested structure given by the four Italian macro-areas were considered. Results. Of the barriers considered in this study, only two were found to be significantly associated with healthcare utilization. Specifically, they are long waiting lists for specialist service accessibility (adjOR = 1.20, 95% CI (1.07; 1.35)) and very expensive exams for dental visit accessibility (adjOR = 0.84, 95% CI (0.73; 0.96)). Another important result was the evidence of an increasing north–south gradient for all of the considered barriers. Conclusion. In Italy, healthcare access is generally guaranteed for all of the services, except for specialist and dental visits that face a waiting time and financial barriers. However, barriers to healthcare were differentiated by income and sex. The north–south gradient for healthcare utilization could be explained through the existing differences in organizational characteristics of the several regional healthcare services throughout Italy.
Highlights
The Italian National Health Service (INHS) promotes equity and the reduction of geographic inequalities in the supply of services
This paper aims to explore whether and how the probability of encountering one of the above-mentioned barriers varies among individuals with different SES and healthcare utilization, such as a visit to the general practitioners (GPs), to a specialist, hospitalization or a dental visit
Considering the binary nature of the response variables to model healthcare access related to SES and services utilization and due to the stratified design used to collect the data analyzed, we used a set of two-level variance components of logistic regression models with a nested structure given by four macro-areas (North–West, North–East, Centre and South-Islands)
Summary
The Italian National Health Service (INHS) promotes equity and the reduction of geographic inequalities in the supply of services. INHS ensures high quality in healthcare services related to hospital admissions, emergency care, the services of general practitioners (GPs), and pediatricians. The principles are related to universal coverage and non-discriminatory access to healthcare services. The general objectives and fundamental principles for the INHS, together with the so-called “essential levels of care” (LEA Decree, dated 29 November 2001) are set at the national level. Through the LEAs, the Ministry of Health selects the categories of services delivered at the hospital level to all of the citizens and allocates national funds to the regions. Regional governments are responsible for administrative healthcare functions, planning healthcare activities, organizing supply in relation to population needs, as well as monitoring the quality, appropriateness, and efficiency of the services provided.
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