Testing health expenditure rationing under universal healthcare coverage: the case of Italy

TL;DR

This paper examines how income influences private health expenditure in Italy, revealing income-based disparities even after accounting for health needs, indicating structural inequities in healthcare access.

Contribution

It provides empirical evidence on income-related disparities in out-of-pocket health spending under Italy's universal healthcare system, highlighting structural inequities.

Findings

Higher income individuals spend about 300 euros more annually.

Income significantly explains variation in private health expenditure.

Disparities persist after controlling for health status and socio-demographics.

Abstract

We investigate the phenomenon of (private, out-of-pocket) "health expenditure rationing", or whether out-of-pocket health expenditures are shaped by income independently of actual health needs. Using microdata from an Italian Health Interview Survey, we assess the extent to which income explains variation in private health spending, after controlling for objective health conditions, self-assessed health, and a comprehensive set of socio-demographic factors. We find that individuals in the highest income brackets spend approximately 300 euros more annually than those in the lowest. Our findings point to a structural inequity in access and highlight the need for policy measures that address not only formal coverage but also the underlying role of income in shaping healthcare use.