Availability, Accessibility, and Equity: a multidimensional approach to mapping health poverty across Italian municipalities

This paper proposes a novel territorial and multidimensional approach to measuring health poverty in Italy at the municipal level. Using a particular rich and unique database, we develop a Multidimensional Health Poverty non -compensatory Index based on three key dimensions: availability, accessibility, and equity of healthcare services. Results reveal a weak link between health poverty and health status, highlighting the former’s limits as a proxy in countries with good average outcomes but growing access inequalities. The analysis also shows that investing in inner areas, balancing public and private services, and reducing unmet care needs and impoverishing health costs are key to tackling high health poverty, especially where elderly or disability care dominates spending. Finally, SEM models results and the different types of healthcare systems based on health poverty levels and type of governance emerging, show the effectiveness of pursuing both equity and efficiency goals in healthcare.