Ability to pay and equity in access to Italian and British National Health Services.
BACKGROUND
Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services.


METHODS
Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries.


RESULTS
78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years.


CONCLUSIONS
Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal 'free of charge' way of access.
Domenighetti
Gianfranco
G
Institute of Public Communication and Education, Institute of Microeconomics and Public Economics, University of Lugano, Via Buffi 13, Lugano, Switzerland. gianfranco.domenighetti@usi.ch
Vineis
Paolo
P
De Pietro
Carlo
C
Tomada
Angelo
A
D000328:Adult; D000368:Aged; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D016015:Logistic Models; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014850:Waiting Lists