Inequities of access to health care in Italy: The role of socioeconomic status

In this paper we analyze the relationship between socioeconomic status and utilization of health care services in contemporary Italy. When it was established in 1978, the Italian National Health Service was supported by a consensus that health care should be financed according to ability to pay but distributed according to need, thereby setting out equity objectives in terms of both financial contributions and access to care. However, as it has emerged from several exploratory analyses, in practice this goal is far from being completely achieved.

We use the 2004/05 Health Conditions and Access to Health Services Survey, a cross-sectional survey on a large probability sample of the Italian population (n = 107,605). First, we use multilevel regression modeling to estimate how and to what extent the opportunities of Italian citizens to access (utilize) a given set of health services (preventive check-ups, general practitioners visits, specialist visits, diagnostic check-ups, hospitalization) are associated with their socioeconomic status; in this step, we use need (health status) as a standard control variable. Second, we replicate the analyses using need as a potential effect-modifier variable, to investigate whether the association between individuals’ socioeconomic status and their realized access to health care services varies across levels of need.

Our analyses show that (a) a significant positive association between socioeconomic status and probability to access the selected health services exists among the study population; (b) this association does vary across levels of need, and it is shaped differently for the different indicators examined. We conclude that some degree of socioeconomic inequity does characterize the realized access to health care in Italy. Moreover, for some of the services we analyze, need modifies the association of interest playing a major role in shaping this inequity.