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.
Institute of Public Communication and Education, Institute of Microeconomics and Public Economics, University of Lugano, Via Buffi 13, Lugano, Switzerland. gianfranco.domenighetti@usi.ch
Gianfranco
G
Domenighetti
Paolo
P
Vineis
Carlo
C
De Pietro
Angelo
A
Tomada
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