Financial Problems and Unmet Needs for Medical Care in Italy for Migrants during the Global Recession

Background: There is evidence of the effect of financial problems on health inequalities in Europe during the global financial crisis (Filippini, Giannoni and Greene, 2017) but not on their effects on access to medical care. Objectives: This paper analyses the effects of financial difficulties as measured by over-indebtedness on unmet needs for medical care in Italy during the global financial crisis as well as the relationship between these two types of problems. A second objective is to understand if the migrant population experienced the same level of problems in access to health care and in financial difficulties, as the general population during the crisis. Methods and data: The first measure of financial exclusion used is based on over-indebtedness defined as follows: ‘People are over- indebted if their net resources (income and realisable assets) render them persistently unable to meet essential living expenses and debt repayments as they fall due.’ Other measures used are having difficulties in preparing meals (food insecurity) and housing tenure status (having to pay for a mortgage or house rental). The data used are from the Eurostat 2012 Cross-sectional wave of the of EU-SILC survey for Italy, a representative sample of adult population (n= 39,345). By using Generalized structural equation (GSEM) modelling the probability of reporting unmet needs for medical and dental care is estimated together with the probability of reporting financial problems. All estimates are obtained after controlling for several demographic, geographic (area of residence) and socio-economic (income, education, occupational status). Moreover, other dimensions of household economic and financial security are included. The effects of these determinants on unmet needs for medical care are reported for both the general poulation and the non-EU born or citiziens regularly living in Italy. First results show that financial over-indebtedness is a relevant determinant of unmet needs for medical care and dental care in Italy for both population groups. This work contributes to the existing literature on socio-economic determinants of access to health care by bringing evidence on a rather new research topic. Moreover, it provides initial evidence on the pathway through which financial exclusion can influence access to health care in Italy