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Ability to pay and equity in access to Italian and British National Health Services

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  • Domenighetti, Gianfranco 1 Institute of Public Communication and Education, Institute of Microeconomics and Public Economics, University of Lugano Lugano, Switzerland
  • Vineis, Paolo 2 Imperial College London, St Mary's; Campus, Norfolk Place, London, UK
  • De Pietro, Carlo 3 Public Management and Policy Department, SDA Bocconi School of Management, Via Bocconi 8, Milano, Italy
  • Tomada, Angelo 4 Institute of Public Communication and Education, University of Lugano, Via Buffi 13, Lugano, Switzerland
    2010
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  • European Journal of Public Health. - Oxford University Press. - 2010, vol. 20, no. 5, p. 500-503
English Background: Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services. Methods: Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries. Results: 78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years. Conclusions: Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal ‘free of charge' way of access
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  • English
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Medicine
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© The Author 2010. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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