Measuring Regional Performance in the Italian NHS: Are Disparities Decreasing?

Given the regional disparities that historically characterize the Italian context, in this paper we propose a framework to evaluate the regional health care systems' performance in order to contribute to the debate on the relationship between decentralisation of health care and equity. To investigate the regional health systems performance, we refer to the OECD Health Care Quality Indicators project to construct of a set of five composite indexes. The composite indexes are built on the basis of the non-compensatory Adjusted Mazziotta-Pareto Index, that allows comparability of the data across units and over time. We propose three indexes of health system performance, namely Quality Index, Accessibility Index and Cost-Expenditure Index, along with a Health Status Index and a Lifestyles Index. Our framework highlights that regional disparities still persist. Consistently with the evidence at the institutional level, there are regions, particularly in Southern Italy, which record lower levels of performance with high levels of expenditure. Continuous research is needed to provide policy makers with appropriate data and tools to build a cohesive health care system for the benefit of the whole population. Even if future research is needed to integrate our framework with new indicators for the calculation of the indexes and with the identification of new indexes, the study shows that a scientific reflection on decentralisation of health systems is necessary in order to reduce inequalities.

Broken Trust. Confidence Gaps and Distrust in Latin America.

Latin American societies show lower levels of political trust when compared to other regions of the world. The lack of trust in institutions can led to ineffective management of public affairs, social crises, lack of transparency, economic problems and even difficulties in countering pandemics. The objective of this work is to build an index (LADI) that provides a measure of the level of perceived distrust in the institutions of the different Latin American countries and its variations over the period from 2008 to 2018. The data used for this analysis are of a subjective nature and come from the series of surveys provided by Latinobarómetro. To develop the analysis, we have used a quantitative approach of a partially non-compensatory aggregative type, known as Adjusted Mazziotta and Pareto Index. The results show a generalized increase of distrust in the years 2017 and 2018 for several Latin American countries. On the other hand, in countries where the rule of law is more consolidated, a best perception of the functioning of democracy emerges.

Is Pollution a Cost to Health? Theoretical and Empirical Inquiry for the World's Leading Polluting Economies.

Making development sustainable in the long run is the goal of policy makers of countries all over the world. To attain such a goal, countries have to face the dynamics of pollution-income interactions in both the short and long run, which are observed along the well-known Environmental Kuznets Curve (EKC). In the short run stage of the EKC, rising income and rising health expenditure may lead to rising pollution, while in the long run, as pollution continues, health expenditures increase, besides conservation of capital investment. The former is a common phenomenon in developing economies and the latter in the developed economies. Hence, there are both theoretical and empirical questions on whether health expenditures are caused by environmental pollution or not. The present study has attempted to investigate the issue from the theoretical point of view, through the endogenous growth framework, and by considering empirical observations for the world's top 20 polluting countries for the period 1991-2019. The results show that per capita health expenditure and per capita pollution are cointegrated in the majority of the countries. However, in the short run, pollution is the cause of health expenditures for many developed countries in the list, and health expenditures are the cause of pollution in some of the developing countries. The results justify the claim of the endogenous growth model incorporating pollution and health expenditure.

The role of regional health systems on the waiting time inequalities in health care services: Evidences from Italy.

Inequalities in effective access to healthcare are present among countries and within the same country. Despite in Italy exist the principle of equity in access to health system, there are evidence of different access rates in the form of unequal waiting time within the country. Waiting times are an instruments to ration healthcare services dealing with resource scarsity. Theoretically, it is a fair tool because waiting times should depend only on health needs and not on the ability to pay. However, a growing literature has pointed out that belonging to a particular socioeconomic status leads to waiting times inequalities for healthcare services. Many countries have socioeconomic disparities among regions, and healthcare organizations need to take into account these differences. The increasing power of Regional Health Authorities in decentralized health systems, as in the case of Italy, has generated different organizational ways to provide health care, possibly leading to different access rates in the form of unequal waiting time within the country. This paper aims to understand if the administrative area (Regional Health Authorities) in charge of health services affects waiting times lowering or strengthening health care access inequalities. Using a series of logistic regression models, this work suggests the presence of two vectors: socioeconomic inequalities and regional inequalities. Health organizations need to implement different kinds of answers for each vectors of inequalities.

Non-compensatory aggregation method to measure social and material deprivation in an urban area: relationship with premature mortality.

Health inequalities exist between nations, regions, and even smaller units. In societies where social and economic structures change rapidly and continuously, analysis of health socioeconomic determinants plays a fundamental role to provide proper policy answers. This study aims to measure accurately two different conceptions of deprivation by developing two different indexes using non-compensatory among sub-indicators aggregation methods. The proposed indicators are compared with premature mortality to verify deprivation's effect on health status. The results show that materially deprived areas are not necessarily socially deprived and vice versa. Material deprivation has a positive statistical co-graduation with premature mortality, while social deprivation has no association with premature mortality.

Socioeconomic Status and Waiting Times for Health Services: Current Evidences and Next Area of Research.

Waiting times are an issue in many countries, excessive waiting for treatments may deteriorate patient's health status and reduce treatment effectiveness potentially, becoming a barrier in the access to health care services. Waiting time to be equitable should be related only to the health need, people with the same health need have to wait the same time, without any difference due to socioeconomic status. In the commentary, the results of the extensive literature review and policy implications are discussed.

Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System.

In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002-2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower.

Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival.

During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.

Material versus social deprivation and health: a case study of an urban area.

Socioeconomic factors are one of the main determinants of health inequalities. However, which component of socioeconomic status affects health most and how that relationship should be measured remains an open question. The aim of this study was to compare material and social deprivation indexes in order to determine which better explains health inequalities within an urban area. Following a review of the literature on small area deprivation indexes, a case study of the Italian city Genoa is presented. The city of Genoa is split into 71 small areas [urbanistic units (UU)], each of which has about 9,500 inhabitants. For each small area, socioeconomic indicators were extracted from the 2001 Census, whereas health indicators were computed from the death registry for 2001-2003. Factorial analyses was used to choose the deprivation variables, which were utilised to create two distinct deprivation indexes referring to material and social deprivation, respectively. Both deprivation indexes are positively correlated with health status proxied by standardised mortality ratios (SMRs) under 65. The material index, however, correlates more highly with SMRs than the social index, and thus the material index is the more suitable measure to explain variations in premature mortality within an urban area. Moreover, the two indexes must be kept distinct.