title: Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.
abstract: Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations.
authors.affiliation: Università degli Studi di Firenze, Dipartimento di Medicina Sperimentale e Clinica, Health Services Research Unit, Largo Brambilla, 3, 50134 Firenze, Italy; OCPS (Observatory on Private Healthcare Consumption), SDA Bocconi - School of Management, Via Bocconi 8, 20136 Milano, Italy. Electronic address: mario.delvecchio@unifi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Del Vecchio
authors.affiliation: OCPS (Observatory on Private Healthcare Consumption), SDA Bocconi - School of Management, Via Bocconi 8, 20136 Milano, Italy. Electronic address: lorenzo.fenech@sdabocconi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fenech
authors.affiliation: SDA Bocconi - School of Management, CeRGAS (Centre for Research on Health and Social Care Management), Bocconi University, Via Roentgen, 1, 20136 Milano, Italy. Electronic address: anna.prenestini@unibocconi.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Prenestini
mesh_terms: D016208:Databases, Factual; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D005382:Financing, Personal / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D009313:National Health Programs; D017150:Public Sector / Q000191:economics*; D011787:Quality of Health Care
keywords: Beveridge systems; Private household consumption; Private mix; Public; Quality of health care systems