Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-02-14 DOI:10.1016/j.healthpol.2025.105271

Elenka Brenna

{"title":"Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance","authors":"Elenka Brenna","doi":"10.1016/j.healthpol.2025.105271","DOIUrl":null,"url":null,"abstract":"<div><div>In the Italian NHS, over the last decades, a growing share of population opted for a Voluntary Health Insurance (VHI) in order to privately access healthcare services and bypass the increasingly long waiting times of the public system.</div><div>The study analyses whether and to what extent the presence of a VHI may condition the choice of privately accessing healthcare services. Information on different access fees, specifically “full price”, “copayment price” and “no price”, are furnished for both specialist visits and diagnostic tests; the analysis is focused on these services.</div><div>Data is drawn from the European Health Interview Survey, and is modelled through Propensity Score Matching to find possible differences in the choice of accessing private, rather than public, healthcare services by individuals with VHI.</div><div>Results show a higher likelihood of accessing private specialist (+7.3 %) and diagnostic care (+7.3 %) by patients with a VHI compared to patients without VHI; conversely, having a VHI decreases the probability of seeking NHS care, through copayment, by respectively 5.1 % and 6.3 %. These findings suggest that the spread of VHI may reduce the burden on the NHS and increase the availability of diagnostic and specialist services for patients without integrative coverage.</div><div>On the other side, the analysis shows that income, education and employment status are directly related to the probability of having a VHI, raising concern on possible inequalities across socioeconomic classes in the access to healthcare services. Policy implications are not univocal and claim for a deeper insight into these aspects by both scholars and policymakers.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"154 ","pages":"Article 105271"},"PeriodicalIF":3.6000,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Policy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0168851025000272","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

In the Italian NHS, over the last decades, a growing share of population opted for a Voluntary Health Insurance (VHI) in order to privately access healthcare services and bypass the increasingly long waiting times of the public system.

The study analyses whether and to what extent the presence of a VHI may condition the choice of privately accessing healthcare services. Information on different access fees, specifically “full price”, “copayment price” and “no price”, are furnished for both specialist visits and diagnostic tests; the analysis is focused on these services.

Data is drawn from the European Health Interview Survey, and is modelled through Propensity Score Matching to find possible differences in the choice of accessing private, rather than public, healthcare services by individuals with VHI.

Results show a higher likelihood of accessing private specialist (+7.3 %) and diagnostic care (+7.3 %) by patients with a VHI compared to patients without VHI; conversely, having a VHI decreases the probability of seeking NHS care, through copayment, by respectively 5.1 % and 6.3 %. These findings suggest that the spread of VHI may reduce the burden on the NHS and increase the availability of diagnostic and specialist services for patients without integrative coverage.

On the other side, the analysis shows that income, education and employment status are directly related to the probability of having a VHI, raising concern on possible inequalities across socioeconomic classes in the access to healthcare services. Policy implications are not univocal and claim for a deeper insight into these aspects by both scholars and policymakers.

查看原文本刊更多论文

意大利国家医疗服务体系中的公共与私人访问-使用倾向评分匹配来提供更多关于自愿医疗保险日益普及的见解

在意大利国民保健制度中，在过去的几十年里，越来越多的人口选择自愿健康保险（VHI），以便私人获得医疗保健服务，并绕过公共系统越来越长的等待时间。该研究分析了VHI的存在是否以及在多大程度上可能影响私人获得医疗保健服务的选择。提供了关于不同访问费用的信息，特别是关于专家访问和诊断测试的“全价”、“共同支付价格”和“免费”；分析的重点是这些服务。数据来自欧洲健康访谈调查，并通过倾向得分匹配建立模型，以发现患有VHI的个人在选择获得私人而不是公共医疗保健服务方面可能存在的差异。结果显示，与没有VHI的患者相比，VHI患者获得私人专科医生（+ 7.3%）和诊断护理（+ 7.3%）的可能性更高；相反，通过共同支付，VHI降低了寻求NHS护理的可能性，分别为5.1%和6.3%。这些发现表明，VHI的传播可能会减轻NHS的负担，并为没有综合覆盖的患者增加诊断和专科服务的可用性。另一方面，分析表明，收入、教育和就业状况与患VHI的可能性直接相关，这引起了人们对不同社会经济阶层在获得保健服务方面可能存在的不平等现象的关注。政策影响并不是单一的，需要学者和政策制定者对这些方面进行更深入的了解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.