Ability to pay and equity in access to Italian and British National Health Services

Abstract

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.

High Out‐of‐Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries

“…The complicated nature of health care and health insurance benefits; the complex ways in which consumers respond to insurance benefits and their limits; and finally the often significant health risks not covered by insurance policies: all of these combine to leave large numbers of people across many countries devoting considerable resources to meeting their health care needs (see Domenighetti et al. ; Law et al. ; and Rosenthal ).…”

“…The finding that the United States is not an outlier when it comes to the financial burden resulting from health care consumption in the sample of countries here highlights the fact that health insurance in many countries is commonly porous: high levels of OOP spending frequently occur in many countries despite universal insurance and the existence of policies that supposedly limit citizens' financial exposure (Paris, Devaux, and Wei 2010;Zare and Anderson 2013;Commonwealth Fund 2013). The complicated nature of health care and health insurance benefits; the complex ways in which consumers respond to insurance benefits and their limits; and finally the often significant health risks not covered by insurance policies: all of these combine to leave large numbers of people across many countries devoting considerable resources to meeting their health care needs (see Domenighetti et al 2010;Law et al 2013;and Rosenthal 2015). Considering this evidence, then, solving the problem of the uninsured in the United States will most likely leave standing the separate one of underinsurance, unless policy explicitly seeks to tackle them both.…”

Sociodemographic and health service organizational factors associated with the choice of the private versus public sector for specialty visits: Evidence from a national survey in Italy

“…Previous research [1,[5][6][7][8] has highlighted that Italians choose the private sector for a number of reasons: 1) waiting times for private consultations are usually much shorter than those offered by public facilities; 2) patients may consider that certain private providers offer higher quality services than those guaranteed by the NHS; 3) patients may wish to choose a given health professional (this right is not envisaged in public facilities); 4) private facilities may be closer or more convenient to reach than public ones; 5) in some cases, the cost of a private consultation is comparable to the co-payment charged by the NHS.…”

Private health care expenditure and quality in Beveridge systems: Cross-regional differences in the Italian NHS

“…On the contrary, at a microeconomic level, there are models but there is a lack of data [13]. In this second case, the gap between theory and empirical evidence has been slightly reduced in the last decade thanks to "ad hoc" investigations by researchers or through innovative institutional surveys, such as the SHARE (Survey of Health, Ageing and Retirement in Europe) database [14][15][16][17][18].…”