Perceived quality of public services, liquidity constraints, and the demand of private specialist care

Abstract

In this article we offer direct evidence on the role of perceived quality differences in publicly provided health care services, in determining the incentive to opt out for private services and, for poor individuals, short-run credit constraints in the access to these services. We concentrate on private specialist care, a category of services for which disparities in the access are highest. We use Bank of Italy—SHIW data to first study the determinants of demand for private and public specialist care, estimating probit and bivariate probit models, and ZIP models. We then apply the Carneiro–Heckman procedure to identify the share of people constrained and study how perceived quality of public services affects the percentage of people short run constrained. Our estimates suggest the presence of large territorial differences, as for the role of income and the quality of public services.