The coexistence of public and private funding is a feature common to many healthcare systems: private funding ranges from 15% to 30% of total healthcare expenditure in OECD countries. The mix between public and private consumption is influenced by the choices of the consumers on “opting-out” or “topping-up” the public services with private ones and, according to literature, these consumption decisions have two main determinants: (a) quality of healthcare system, and (b) household income (Levaggi and Turati, 2011; Fabbri and Monfardini, 2011; Regidor et al., 2008). A previous research analyzed the association between the 21 Italian Regional Healthcare Systems (IRHSs) quality levels (using micro-data from ISTAT –National Bureau of Statistics- and several regional quality indicators) and private healthcare expenditure (Del Vecchio et al., 2015). That study found a positive correlation between quality in the public sector and private spending per capita across regions in 2011; when accounting for influence of income no correlation was found. These results undermine the simplistic notion that higher level of private spending are a direct consequence of poor quality in the public sector.
The proposed paper aims at filling the main limitations of the previous study, deepening the analysis of the relationship between the quality of healthcare systems and private consumption. First of all, we will consider separately the different typologies of healthcare services: consultations of physicians in specialist practice; services of medical analysis, laboratories and X-Ray centers; hospital services; rehabilitation services. Secondly, the study will take into account consumption in real terms (e.g. number of visits) as well as their economic value (patient expenditure). The study uses the latest micro-data released by ISTAT in 2014 on “Health conditions and healthcare services consumption”: this is the most comprehensive survey on healthcare conditions and behaviours involving about 60.000 Italian families. Implications for public policy and management practices will be discussed.
References
Levaggi R, Turati G. Spesa sanitaria pubblica e privata: sostituti o complementi?. In: De Vincenti C, Finocchi Ghersi R, Tardiola A, editors. La Sanità in Italia: organizzazione, governo, regolazione, mercato. Bologna: Il Mulino; 2011.
Fabbri D, Monfardini C, Opt out or top up? Voluntary healthcare insurance and the public vs. private substition. 2011, WP 11/28, University of York.
Regidor E, Martinez D, Calle ME, Astasio P, Ortega P, Dominguez V. Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Services Research 2008; 8:183. doi:10.1186/1472-6963-8-183.
Del Vecchio M, Fenech L, Prenestini A, Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS, Health Policy. 2015, 119(3):356-366.
