IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v130y2023ics0168851023000374.html
   My bibliography  Save this article

Geographical variation in the use of private health insurance in a predominantly publicly-funded system

Author

Listed:
  • Cavazza, Marianna
  • Vecchio, Mario Del
  • Fattore, Giovanni
  • Fenech, Lorenzo

Abstract

We provide evidence of geographical variations in the use of private health insurance (PHI) in Italy. Our study offers an original contribution, using a 2016 dataset on the use of PHI amongst a population of more than 200,000 employees of a major company. The average claim per enrolee was €925, representing approximately 50% of public health expenditure per capita, primarily for dental care (27.2%), specialist outpatient services (26.3%) and inpatient care (25.2%). Residents in northern regions and metropolitan areas respectively claimed reimbursements for €164 and €483 more than those in southern regions and in non-metropolitan areas. Both supply and demand factors can explain these large geographical differences. The study suggests the urgency for policymakers to address the considerable disparities in the Italian healthcare system, revealing the overall social, cultural and economic conditions that shape the demand for healthcare.

Suggested Citation

  • Cavazza, Marianna & Vecchio, Mario Del & Fattore, Giovanni & Fenech, Lorenzo, 2023. "Geographical variation in the use of private health insurance in a predominantly publicly-funded system," Health Policy, Elsevier, vol. 130(C).
  • Handle: RePEc:eee:hepoli:v:130:y:2023:i:c:s0168851023000374
    DOI: 10.1016/j.healthpol.2023.104720
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851023000374
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.healthpol.2023.104720?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Toth, Federico, 2014. "How health care regionalisation in Italy is widening the North–South gap," Health Economics, Policy and Law, Cambridge University Press, vol. 9(3), pages 231-249, July.
    2. Marenzi, Anna & Rizzi, Dino & Zanette, Michele, 2021. "Incentives for voluntary health insurance in a national health system: Evidence from Italy," Health Policy, Elsevier, vol. 125(6), pages 685-692.
    3. Ongaro, Edoardo & Ferré, Francesca & Fattore, Giovanni, 2015. "The fiscal crisis in the health sector: Patterns of cutback management across Europe," Health Policy, Elsevier, vol. 119(7), pages 954-963.
    4. West, Patrick, 1991. "Rethinking the health selection explanation for health inequalities," Social Science & Medicine, Elsevier, vol. 32(4), pages 373-384, January.
    5. Robert G. Evans, 1974. "Supplier-Induced Demand: Some Empirical Evidence and Implications," International Economic Association Series, in: Mark Perlman (ed.), The Economics of Health and Medical Care, chapter 10, pages 162-173, Palgrave Macmillan.
    6. Longo, Francesco, 2016. "Lessons from the Italian NHS retrenchment policy," Health Policy, Elsevier, vol. 120(3), pages 306-315.
    7. Fattore, Giovanni & Petrarca, Giuseppina & Torbica, Aleksandra, 2014. "Traveling for care: Inter-regional mobility for aortic valve substitution in Italy," Health Policy, Elsevier, vol. 117(1), pages 90-97.
    8. Colin Vance & Nolan Ritter, 2014. "Is peace a missing value or a zero? On selection models in political science," Journal of Peace Research, Peace Research Institute Oslo, vol. 51(4), pages 528-540, July.
    9. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    10. Léonard, Christian & Stordeur, Sabine & Roberfroid, Dominique, 2009. "Association between physician density and health care consumption: A systematic review of the evidence," Health Policy, Elsevier, vol. 91(2), pages 121-134, July.
    11. Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.
    12. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    13. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.
    14. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    15. Del Vecchio, Mario & Fenech, Lorenzo & Prenestini, Anna, 2015. "Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS," Health Policy, Elsevier, vol. 119(3), pages 356-366.
    16. Mackenbach, Johan P., 2012. "The persistence of health inequalities in modern welfare states: The explanation of a paradox," Social Science & Medicine, Elsevier, vol. 75(4), pages 761-769.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Noto, Guido & Belardi, Paolo & Vainieri, Milena, 2020. "Unintended consequences of expenditure targets on resource allocation in health systems," Health Policy, Elsevier, vol. 124(4), pages 462-469.
    2. Cinzia Di Novi & Anna Marenzi & Dino Rizzi, 2018. "Do healthcare tax credits help poor-health individuals on low incomes?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 293-307, March.
    3. Di Novi, C. & Piacenza, M. & Robone, S. & Turati, G., 2015. "How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy," Health, Econometrics and Data Group (HEDG) Working Papers 15/23, HEDG, c/o Department of Economics, University of York.
    4. Di Novi, Cinzia & Piacenza, Massimiliano & Robone, Silvana & Turati, Gilberto, 2019. "Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    5. Signorelli, C. & Odone, A. & Oradini-Alacreu, A. & Pelissero, G., 2020. "Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary," Health Policy, Elsevier, vol. 124(1), pages 69-74.
    6. Guccio, C. & Pignatora, G. & Vidoli, F., 2023. "It never rains but it pours: Austerity and mortality rate in peripheral areas," Health, Econometrics and Data Group (HEDG) Working Papers 23/02, HEDG, c/o Department of Economics, University of York.
    7. Alexi Gugushvili & Martin McKee & Michael Murphy & Aytalina Azarova & Darja Irdam & Katarzyna Doniec & Lawrence King, 2019. "Intergenerational Mobility in Relative Educational Attainment and Health-Related Behaviours," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 141(1), pages 413-441, January.
    8. Matthew Hauenstein, 2020. "The conditional effect of audiences on credibility," Journal of Peace Research, Peace Research Institute Oslo, vol. 57(3), pages 422-436, May.
    9. Alyson van Raalte & Pekka Martikainen & Mikko Myrskylä, 2014. "Lifespan Variation by Occupational Class: Compression or Stagnation Over Time?," Demography, Springer;Population Association of America (PAA), vol. 51(1), pages 73-95, February.
    10. Cirulli, Vanessa & Marini, Giorgia, 2023. "Are austerity measures really distressing? Evidence from Italy," Economics & Human Biology, Elsevier, vol. 49(C).
    11. Mauro, Marianna & Giancotti, Monica, 2023. "The 2022 primary care reform in Italy: Improving continuity and reducing regional disparities?," Health Policy, Elsevier, vol. 135(C).
    12. Rudoler, David & Laporte, Audrey & Barnsley, Janet & Glazier, Richard H. & Deber, Raisa B., 2015. "Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada," Social Science & Medicine, Elsevier, vol. 124(C), pages 18-28.
    13. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," LSE Research Online Documents on Economics 74066, London School of Economics and Political Science, LSE Library.
    14. Hiroaki Suenaga & Maria Rosalía Vicente, 2022. "Online and offline health information seeking and the demand for physician services," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(3), pages 337-356, April.
    15. Wende, Danny & Kopetsch, Thomas & Richter, Wolfram F., 2020. "Planning health care capacities with a gravity equation," Ruhr Economic Papers 888, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    16. Hoffmann, Rasmus & Kröger, Hannes & Pakpahan, Eduwin, 2018. "Pathways between socioeconomic status and health: Does health selection or social causation dominate in Europe?," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 36, pages 23-36.
    17. Rudy Douven & Remco Mocking & Ilaria Mosca, 2012. "The Effect of Physician Fees and Density Differences on Regional Variation in Hospital Treatments," CPB Discussion Paper 208, CPB Netherlands Bureau for Economic Policy Analysis.
    18. Sarti, Simone & Terraneo, Marco & Tognetti Bordogna, Mara, 2017. "Poverty and private health expenditures in Italian households during the recent crisis," Health Policy, Elsevier, vol. 121(3), pages 307-314.
    19. Donald S. Kenkel & Joseph V. Terza, 2001. "The effect of physician advice on alcohol consumption: count regression with an endogenous treatment effect," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 16(2), pages 165-184.
    20. Campos-Matos, Inês & Kawachi, Ichiro, 2015. "Social mobility and health in European countries: Does welfare regime type matter?," Social Science & Medicine, Elsevier, vol. 142(C), pages 241-248.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:130:y:2023:i:c:s0168851023000374. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.