Cavalieri, Marina (2009): Geographical patterns of unmet health care needs in Italy. Unpublished.
Full text available as:
| PDF - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader 731Kb |
In recent years, health care reforms and restrained budgets have risen concerns about accessibility to health services, even in countries with universal coverage health systems. Previous studies have explored the issue by using objective event-oriented measures such as those related to utilization of health care. Analyzing access through subjective process-oriented indicators allows to better disentangle the process of seeking care, to investigate self-perceived barriers to health services and to account for differences in individual health care preferences. In this paper, data from the 2006 Italian component of the European Survey on Income and Living Conditions (EU-SILC) are used to explore reasons and predictors of self-reported unmet needs for specialist and/or dental care among adult Italians aged 18 and over. Results reveal different patterns across socio-economic groups and geographical macro-areas. Evidence of income-related inequalities and violations of the horizontal equity principle are also found both at a national and regional level. Policies to address unmet health care needs should adopt a multidimensional approach and be tailored so as to consider such heterogeneities.
| Item Type: | MPRA Paper |
|---|---|
| Language: | English |
| Keywords: | Unmet health care needs; access to health care; inequality; inequity; Italy |
| Subjects: | I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health C - Mathematical and Quantitative Methods > C3 - Econometric Methods: Multiple; Simultaneous Equation Models; Multiple Variables; Endogenous Regressors > C31 - Cross-Sectional Models; Spatial Models; Treatment Effect Models |
| ID Code: | 16097 |
| Deposited By: | Dr Marina Cavalieri |
| Deposited On: | 08. Jul 2009 04:35 |
| Last Modified: | 08. Jul 2009 04:35 |
| References: | Aday L.A. and R.M. Andersen (1974), “A framework for the study of access to medical care”, Health Service Research, 9(3): 208-220. Allin S., C. Masseria and E. Mossialos (2006), Inequality in health care use among older people in the United Kingdom: an analysis of panel data, LSE health working paper, 1, School of Economics and Political Science, London. Andersen R.M. (1968), A behavioural model of families’ use of health services, Research Series, Center for Health Administration Studies, The University of Chicago, Chicago. Andersen R.M. (1995), “Revisiting the behavioral model and access to medical care: Does it matter?”, Journal of Health and Social Behavior, 36: 1-10. Anderson R.M. and J. Newman (1973), “Societal and individual determinants of medical care utilization in the United States”, Milbank Memorial Fund Quarterly, 51: 95-124. Atella V., F. Brindisi, P. Deb and F.C. Rosati (2004), “Determinants of access to physician services in Italy: a latent class seemingly unrelated probit approach”, Health Economics, 13(7): 657-668. Bago d’Uva T., A.M. Jones and E. van Doorslaer (2009), “Measurement of horizontal inequity in health care utilization using European panel data”, Journalof Health Economics, 28(2): 280-289. Bryant T., C. Leaver and J. Dunn (2008), “Unmet healthcare need, gender, and health inequalities in Canada”, Health Policy, 91(1): 24-32. Carr W. and S. Wolfe (1976), “Unmet needs as sociomedical indicators”, International Journal of Health Services, 6(3):417–430. Chen J. and F. Hou (2002), “Unmet needs for health care”, Health Reports,13(2): 23-34. Devillanova C. (2007), “Social networks, information and health care utilization: evidence from undocumented immigrants in Milan”, Journal of Health Economics, 27(2): 265-286. Diamant A.L., R.D. Hays, L.S. Morales et al. (2004), “Delays and unmet need for health care among adult primary care patients in a restructured urban public health system”, American Journal of Public Health, 94: 783-789. Fabbri D. and C. Monfardini (2003), “Public vs. private health care services demand in Italy” Giornale degli Economisti, Bocconi University, 62(1): 93-123. Giannoni M. and C. Masseria (2005), “Health system performance and equity in Italy: a disease based approach”, paper presented at the Conference AIES – Associazione Italiana di Economia Sanitaria, 10-11 november 2005, Genoa. Giannoni M., G. Rabito and C. Masseria (eds.) (2007), L’equità nell'accesso alle cure sanitarie: prime stime e confronti interregionali, Le Monografie, 6, Regione Umbria. Giannoni M. (2008), “Measuring horizontal equity in health care utilization in Italy: 2004-2005”, paper presented at the XX Conference SIEP – Società Italiana di Economia Pubblica, Pavia. Gilbert G.H., R.P. Duncan and W.B. Vogel (1998), “Determinants of dental care use in dentate adults: six-monthly use during a 24-month period in the Florida dental care study”, Social Science and Medicine, 47(6):727-37. Grootendorst P.V. (1995), “A comparison of alternative models of prescription drug utilization”, Health Economics, 4: 183-198. Hirschman A.O. (1970), Exit, voice and loyalty: responses to decline in firms, organizations and states, Harvard University Press, Cambridge (Mass.). Huber P.J. (1967), “The behavior of maximum likehood estimates under non-standard conditions”, In: Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, 1: 221–233, University of California Press. Idler E.L. and S.V. Kasl (1995), “Self-ratings of health: do they also predict change in functional ability?”, Journal of Gerontology, 50B: 344-353. Idler E. and Y. Benyamini (1997), “Self-rated health and mortality: a review of twenty-seven community studies”, Journal of Health and Social Behavior, 38(1): 21-37. Istituto Nazionale di Statistica (ISTAT) (2008), L’indagine europea sui redditi e le condizioni di vita delle famiglie (EU-SILC), Roma. Janzen B.L. and N. Muhajarine (2003), “Social role occupancy, gender, income adequacy, life stage and health: a longitudinal study of employed Canadian men and women”, Social Science and Medicine, 57: 1491-1503. Kakwani N., A. Wagstaff, E. van Doorslaer (1997), “Socioeconomic inequalities in health: measurement, computation and statistical inference”, Journal of Econometrics, 77: 87-103. Koolman X. (2007), “Unmet need for health care in Europe”, In: Comparative EU statistics on income and living conditions: issues and challenges, proceedings of the EU-SILC Conference (6-8 November 2006, Helsinki), EUROSTAT, Luxembourg. Koolman X. and E. van Doorslaer (2004), “On the interpretation of a concentration index of inequality”, Health Economics, 13: 649–656. Lerman, R.I. and S. Yitzhaki (1989), “Improving the Accuracy of Estimates of Gini Coefficients”, Journal of Econometrics, 42(1): 43-47. Levesque J-F., R. Pineault, L. Robert et al. (2008), Unmet health care needs: a reflection of the accessibility of primary care services?, Institut National de Santé Publique du Québec, Montréal. Manning W.G. and C.E. Phelps (1979), “the demand for dental care”, Bell Journal of Economics, The RAND Corporation, 10(2): 503-525. Masseria C. (2003), “Equity in the delivery of inpatient care in Italy”, paper presented at the XV Conference SIEP – Società Italiana di Economia Pubblica, Pavia. Mollborn S., I. Stepanikova and K.S. Cook (2005), “Delayed care and unmet needs among health care system users: when does fiduciary trust in a physician matter?”, Health Services Research: 40: 1898-1917. Moret L., J.M. Nguyen, N. Pillet et al. (2007), “Improvement of psychometric properties of a scale measuring inpatient satisfaction with care: a better response rate and a reduction of the ceiling effect”, BMC Health Services Research, 7:1-9. Morris S., M. Sutton and H. Gravelle (2005), “Inequity and inequality in the use of health care in England: an empirical investigation”, Social Science and Medicine, 60(6): 1251-1266. O’Donnell O., E. van Doorslaer, A. Wagstaff and M. Lindelow (2007), Analyzing health equity using household survey data: a guide to techniques and their implementation, The World Bank, Washington. Pagan J.A. and M.V. Pauly (2006), “Community-level uninsurance and unmet medical needs of insured and uninsured adults”, Health Services Research, 41(3): 788-803. Peck B.M., P.A. Ubel, D.L. Roter et al. (2004), ”Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction?” Journal of General Internal Medicine, 19: 1080–7. Pohlmeier W. and V. Ulrich (1995), “An econometric model of the two-part decision making process in the demand for health care”, Journal of Human Resources, 30: 339-61. Pregibon D. (1980), “Goodness of link tests for generalized linear models”, Applied Statistics, 29: 15-24. Sanmartin C., C. Houle, S. Tremblay and J-M. Berthelot (2002), “Changes in unmet health care needs”, Health Reports, 13(3): 15-21. Sanmartin C. and N. Ross (2006), “Experiencing difficulties accessing first-contact health services in Canada”, Health Policy, 1(2):103-119. Shi L. and G. Stevens (2005), “Vulnerability and unmet health care needs: the influence of multiple risk factors”, Journal of General Internal Medicine, 20(2): 148-154. Sintonen, H. and I. Linnosmaa (2000), “Economics of dental services”, In: Culyer, A. and J. Newhouse (eds.), Handbook of Health Economics, Elsevier Science, NorthHolland, Amsterdam. Sitzia J. and N. Wood (1997), “Patient satisfaction: a review of issues and concepts”, Social Science and Medicine, 45: 1829-1843. Tukey J.W. (1949), “One degree of freedom for nonadditivity”, Biometrics, 5: 232-242. Van Doorslaer E. and A. Jones (2003), “Inequalities in self-reported health: validation of a new approach to measurement”, Journal of Health Economics, 22(1): 61-87. Van Doorslaer E., X. Koolman and A.M. Jones (2004), “Explaining income-related inequalities in doctor utilization in Europe”, Health Economics, 13(7): 629-47. Wagstaff A. (2005), “The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality”, Health Economics, 14(4): 429–32. Wagstaff A., P. Paci and E. Van Doorslaer (1991), “On the measurement of inequalities in health”, Social Science and Medicine, 33: 545–557. Wagstaff, A. and E. van Doorslaer (2000), “Measuring and testing for inequity in the delivery of health care”, Journal of Human Resources, 35(4): 716-33. Wagstaff A., E. van Doorslaer and N. Watanabe (2003), “On decomposing the causes of health sector inequalities, with an application to malnutrition inequalities in Vietnam”, Journal of Econometrics, 112(1): 219-27. Westin M., A. Ahs, B.K. Persson and R. Westerling (2004), “A large proportion of Swedish citizens refrain from seeking medical care-lack of confidence in the medical services a plausible explanation?”, Health Policy, 68: 333-44. White H. (1980), “A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity”, Econometrica, 48: 817–830. White H. (1982), “Maximum likelihood estimation of misspecified models”, Econometrica, 50: 1-25. Wilson K. and M.W. Rosenberg (2004), “Accessibility and the Canadian health care system: squaring perceptions and realities”, Health Policy, 67(2): 137-48. Wooldridge J. (2002), Econometric Analysis of Cross Section and Panel Data, MIT Press, Cambridge. Wu Z., M.J. Penning and C.M. Schimmele (2005), “Immigrant status and unmet health care needs”, Canadian Journal of Public Health, 96(5): 369-373. |
All papers reproduced by permission. Reproduction and distribution subject to the approval of the copyright owners.
Repository Staff Only: edit this item