Rationing the public provision of healthcare in the presence of private supplements: evidence from the Italian NHS.
In this paper we assess the relative effectiveness of user charges and administrative waiting times as a tool for rationing public healthcare in Italy. We measure demand elasticities by estimating a simultaneous equation model of GP primary care visits, public specialist consultations and private specialist consultations, as if they were part of an incomplete system of demand. We find that for public specialist consultations, own price elasticity of demand is about -0.3, while elasticity to administrative waiting time is about -.04. No substitution exists between the demand for public and private specialists, so that user charges act as a net deterrent for over-consumption. The public provision of healthcare does not induce the wealthy to opt out. Moreover our evidence suggests that user charges and waiting lists do not serve redistributive purposes.
Fabbri
Daniele
D
Department of Economics, University of Bologna, Italy. d.fabbri@unibo.it
Monfardini
Chiara
C
D003695:Delivery of Health Care / Q000458:organization & administration*; D015276:Health Care Rationing; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D007558:Italy; D008511:Medicine; D017059:Models, Econometric; D009313:National Health Programs / Q000458:organization & administration*; D017149:Private Sector; D013038:Specialization; D014850:Waiting Lists