Department of Economic and Business, University of Catania, Corso Italia 55, Catania 95129, Italy.
Int J Health Geogr. 2013 May 12;12:27. doi: 10.1186/1476-072X-12-27.
Unmet health needs should be, in theory, a minor issue in Italy where a publicly funded and universally accessible health system exists. This, however, does not seem to be the case. Moreover, in the last two decades responsibilities for health care have been progressively decentralized to regional governments, which have differently organized health service delivery within their territories. Regional decision-making has affected the use of health care services, further increasing the existing geographical disparities in the access to care across the country. This study aims at comparing self-perceived unmet needs across Italian regions and assessing how the reported reasons - grouped into the categories of availability, accessibility and acceptability - vary geographically.
Data from the 2006 Italian component of the European Union Statistics on Income and Living Conditions are employed to explore reasons and predictors of self-reported unmet medical needs among 45,175 Italian respondents aged 18 and over. Multivariate logistic regression models are used to determine adjusted rates for overall unmet medical needs and for each of the three categories of reasons.
Results show that, overall, 6.9% of the Italian population stated having experienced at least one unmet medical need during the last 12 months. The unadjusted rates vary markedly across regions, thus resulting in a clear-cut north-south divide (4.6% in the North-East vs. 10.6% in the South). Among those reporting unmet medical needs, the leading reason was problems of accessibility related to cost or transportation (45.5%), followed by acceptability (26.4%) and availability due to the presence of too long waiting lists (21.4%). In the South, more than one out of two individuals with an unmet need refrained from seeing a physician due to economic reasons. In the northern regions, working and family responsibilities contribute relatively more to the underutilization of medical services. Logistic regression results suggest that some population groups are more vulnerable than others to experiencing unmet health needs and to reporting some categories of reasons. Adjusting for the predictors resulted in very few changes in the rank order of macro-area rates.
Policies to address unmet health care needs should adopt a multidimensional approach and be tailored so as to consider such geographical heterogeneities.
在理论上，意大利拥有一个公共资助和普遍可及的医疗体系，因此不应存在未满足的医疗需求。然而，事实似乎并非如此。此外，在过去的二十年中，医疗保健责任逐渐下放给地区政府，这些政府在各自的地区内组织了不同的医疗服务提供方式。地区决策影响了医疗服务的使用，进一步加剧了全国范围内医疗服务获取方面已存在的地域差异。本研究旨在比较意大利各地区之间自我报告的未满足需求，并评估报告的原因——分为可及性、可接受性和可用性这三个类别——在地理上的差异。
本研究使用了 2006 年欧盟收入和生活条件统计调查的意大利部分数据，以探索意大利 45175 名 18 岁及以上受访者自我报告的未满足医疗需求的原因和预测因素。多变量逻辑回归模型用于确定总体未满足医疗需求以及每个三个原因类别的调整率。
结果显示，总体而言，意大利有 6.9%的人口在过去 12 个月内至少经历过一次未满足的医疗需求。未调整的比率在各地区之间差异显著，因此形成了明显的南北差距（东北地区为 4.6%，南部为 10.6%）。在报告未满足医疗需求的人群中，主要原因是与成本或交通相关的可及性问题（45.5%），其次是可接受性（26.4%）和由于等待时间过长导致的可用性问题（21.4%）。在南部，超过二分之一的有未满足需求的人因经济原因而避免看医生。在北部地区，工作和家庭责任相对更能导致医疗服务的未充分利用。逻辑回归结果表明，一些人群比其他人群更容易经历未满足的健康需求，并报告某些类别的原因。调整预测因素后，宏观区域比率的排名几乎没有变化。
解决未满足的医疗需求的政策应采取多维方法，并根据这些地域差异进行调整。
