Growing differences between regional based healthcare service in Italy

Variability in health status can be attributed to three main reasons : differences in lifestyle choices and biological factors, social inequalities based on income, social class and educational qualifications [1], and ecological factors. Studying the latter means to deeply investigate the relationship between environmental features and health conditions of people living there. Recently, some of these studies were devoted to analyse connections between probability of getting sick and the environmental peculiarity of an area (for example the pollution level). Some others focused on local health care service performances and social-economic condition of people benefit from them [2].

In Italy, due to the particular form of healthcare service growing nowadays, researches like these are really significant. Because of a sequence of reforms that had taken place during the 2000s in the Sate Healthcare System (the Servizio Sanitario Nazionale), the regional level has now much more accountabilities than before. This actually has leaded to the existence of a plurality of different regional based services [3]. In addiction, by means of setting basic assistance levels and the model of their allocation, practices of offer rationalization could now concur in generating new social inequalities. With this article, the authors try to understand how social assistance services affects health inequalities on a regional basis.

Regional welfare indicators : demand, supply and performances

Regional differences in healthcare services have been analysed looking at three fundamental aspects : demand, supply and performances. The first can be divided in two facets : the demographic one (which correspond to mortality rates and percentage of individuals older than 65) and health needs (medicine consumption, percentage of disabled people older than six years and of people with a chronic disease). The health supply can also be seen as composed of two part : one referred to service structures (number of doctors and beds in hospital and residential structures, health expenditure per capita and presence of CAT equipment), and one to extra health-services (non-hospital medical and clinical laboratories). The last indicator deals with healthcare service performance and refers on two aspects : functionality (computed by percentage of : hospitalisations, voluntary discharge from hospital, caesarian births and integrated home care) and attractiveness (considered by means of measuring the grade of satisfaction for health are services). The following table one points out that Italian Sate Healthcare System is characterized by a high heterogeneity.

Differences among regions by means of welfare indicators

DemandSupplyPerformance
Demo-
graphic
Health NeedsService StructuresExtra health servicesFunctionalityAttrac-
tiveness
NorthAosta Valley+-++
Piedmont++---
Lombardy------+
Trentino Alto-Adige---+-+-
Veneto----++
Friuli Venezia Giulia++-++++
Liguria++++++++-
Emilia Romagna++++
CenterToscany++-+
Umbria+++++
Marche+
Lazio++++
Abruzzo+
Molise+++++++++
SouthCampania-------
Puglia----+
Basilicata+-
Calabria+
Sicily++++-
Sardinia++

So, while centre regions shows a high demand of health services, the northern ones highlights health needs below the average. Also Southern regions points out a quite different profile from the regions of the North. Beside the low demand in terms of demographic aspects, the firsts have a need for service structures, which is complementary to the low satisfaction for the performances of the existing healthcare system. To summarize, the regions that illustrate the better situation are the northern.

Does regional disparities affect social inequalities ?

Exploiting ISTAT [4] data on the perceived and physical health status of individuals, the authors try to give an answer to this relevant ad interesting question. Relying on multivel models they estimated how much of the variance in health status can be attributed to individual component and how much to contextual conditions. The analysis carried out emphasize not only the prevailing role of personal characteristics like sex, age and personal qualification on the contextual features, but also the extreme difficulty in finding social-institutional factors on a regional basis capable of deal with the low regional variance. In conclusion, despite the presence fo local inequalities, they do not seem to influence the perceived and physical health status of individuals.

Notes

[1Cardano 2008 ; Mulatu e Schooler 2002 ; Costa e Ponti 1990

[2van Doorslaer et al. 2000 ; Waters 2000

[3Formez 2007 ; Asr 2007

[4Istat is the Italian Statistic Institute and the data used come from the “Indagine Multiscopo” carried out in 2005.


This work is appeared as chapter in “Dimensioni della disuguaglianza in Italia” edited by Andrea Brandolini, Chiara Saraceno and Antonio Schizzerotto. This report has been funded by Ermanno Gorrieri Foundation.
This summary is edited by Loris Vergolini.

References :

  • Asr (2007). “Disuguaglianze in cifre”, Emilia Romagna region, Dossier n. 145.
  • Cardano, M. (2008). “Disuguaglianze sociali di salute. Differenze biografiche incise nei corpi”, « Polis », n.1, pp. 119-146.
  • Costa, G. e Ponti, A. (1990). “La Mortalità per Classi Sociali : Differenze o Disuguaglianze ?”, « Polis », n. 3, pp. 423-445.
  • Formez (2007). “I sistemi di governance dei servizi sanitari regionali”, « Quaderni », n 57.
  • Mulatu, M.S. e Schooler, C. (2002). “Causal connections between socio-economic status and health : reciprocal effects and mediating mechanisms”, « Journal of Health and Social Behavior », 43, n. 1, pp. 22-41.
  • van Doorslaer, E., Wagstaff, A., van der Burg, H., Christiansen, T., De Graave, D., Duchesse, I. et al. (2000). “Equity in the delivery of the health care in Europe and the U.S.”, « Journal of Health Economics », 19, n. 5, pp. 553-558.
  • Waters, H.R. (2000). ”Measuring equity in access to health care”, « Social Science and Medicine », 51, n. 4, pp. 599-612.

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12 novembre 2012

Thèmes : • Santé • Conditions de vie

Analyses

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