Objective: To provide new empirical evidence on the socio-economic (SES) and health determinants of specialist and diagnostic care utilization in Italy Data: ISTAT “Multiscopo” survey on Italians health conditions and use of health services (2011-2012). This survey is conducted every 5 years, with the aim of evaluating the prevalence of chronic health conditions and the use of the health care services in the Italian population (n=119,073). All respondents were included (aged from 0 to 100 years). Our dependent variables are the number of specialist visits, diagnostic tests (blood and urine), diagnostic specialist care services (RMN, CT Scans etc.) individuals used during the last 4 weeks preceding the interview. The independent variables are SES (low household income (self reported), citizenship status, employment conditions, civil status, exemptions etc..); demographic (age, sex); and geographical areas (North-West, North-east, Centre, South and Islands). Newly with respect to previous evidence we look at various measures of health status conditions and at different types of chronic diseases (diabetes, cancer, hypertension etc.). Methodology We estimate and compare different models for count data for each dependent variable: Poisson, Negative Binomial, Two-Part/Hurdle, Finite Mixture, including Finite Mixture Hurdle models. Results The best models found were double hurdle with zero inflated negbin (ZINB) (diagnostic care) and Finite Mixture (FMM) (specialist care). Poor socio-economic status and foreign citizenship are generally associated with lower use/access to health services. As expected, consumption of all types of services increases with bad health conditions. Marginal effects are positive and significant for most chronic diseases, with cancer showing the highest effect for diagnostic care among all different types of diseases. Living in Central Italy has a positive effect on consumption. All SES are significant determinants for being no/low users, while in most models only health conditions and being exempted from payment are significant determinants for being among the high users of services. Discussion Although reliable data on the demand for public and private services were not available from the survey, there is evidence that socio-economic and geographical factors affect relatively more non users /lower users than the high users. There is the need of improving access policies to specialist and diagnostic care in Italy.

Determinants of inequalities in utilization of specialist and diagnostic care: the case of Italy

vanessa cirulli
Writing – Original Draft Preparation
;
margherita Giannoni
Supervision
2018-01-01

Abstract

Objective: To provide new empirical evidence on the socio-economic (SES) and health determinants of specialist and diagnostic care utilization in Italy Data: ISTAT “Multiscopo” survey on Italians health conditions and use of health services (2011-2012). This survey is conducted every 5 years, with the aim of evaluating the prevalence of chronic health conditions and the use of the health care services in the Italian population (n=119,073). All respondents were included (aged from 0 to 100 years). Our dependent variables are the number of specialist visits, diagnostic tests (blood and urine), diagnostic specialist care services (RMN, CT Scans etc.) individuals used during the last 4 weeks preceding the interview. The independent variables are SES (low household income (self reported), citizenship status, employment conditions, civil status, exemptions etc..); demographic (age, sex); and geographical areas (North-West, North-east, Centre, South and Islands). Newly with respect to previous evidence we look at various measures of health status conditions and at different types of chronic diseases (diabetes, cancer, hypertension etc.). Methodology We estimate and compare different models for count data for each dependent variable: Poisson, Negative Binomial, Two-Part/Hurdle, Finite Mixture, including Finite Mixture Hurdle models. Results The best models found were double hurdle with zero inflated negbin (ZINB) (diagnostic care) and Finite Mixture (FMM) (specialist care). Poor socio-economic status and foreign citizenship are generally associated with lower use/access to health services. As expected, consumption of all types of services increases with bad health conditions. Marginal effects are positive and significant for most chronic diseases, with cancer showing the highest effect for diagnostic care among all different types of diseases. Living in Central Italy has a positive effect on consumption. All SES are significant determinants for being no/low users, while in most models only health conditions and being exempted from payment are significant determinants for being among the high users of services. Discussion Although reliable data on the demand for public and private services were not available from the survey, there is evidence that socio-economic and geographical factors affect relatively more non users /lower users than the high users. There is the need of improving access policies to specialist and diagnostic care in Italy.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1464627
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