Health needs, demand for health services and expenditure across social groups in Italy: An empirical investigation

The shortage of empirical studies on socio-economic factors influencing demand for health care and inequalities across social groups is dramatic in the case of Italy. The present study aims at discussing these issues, although its results are to be considered mainly methodological, given the small dimension of the sample (n=807). A survey was carried out in a 'qualitative' sample of 9 Local Health Units of different Italian regions. Attention was paid to report every 'illness episode', considered as a cause of demand for health services, within the reference period (4 weeks) in order to properly link health needs with utilization of health services and relative expenditure. The assessment of health status across social groups, using 4 different indicators, shows the weakest social groups as the most vulnerable. The same groups report higher per capita health services uses and expenditures than their morbidity conditions would require. Assuming equity to be defined as 'equal use for equal need' a particular use-need ratio is developed (i.e. health services used per illness episode) able to capture the 'intensity' of health services use and expenditure per need. The 'over-equity' towards the less favoured groups is interpreted as a possible accomplishment of the N.H.S. fundative goals. A structural model of determinants of health services utilization, carried out through the LISREL technique (R2=0.36), confirms the irrelevance of the social variables with respect to need variables.