National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
Italian National Institute of Health (ISS), Rome, Italy.
BMC Public Health. 2019 Sep 2;19(1):1202. doi: 10.1186/s12889-019-7502-x.
In Italy, the number of individuals who have forgone medical examinations or treatments for economic reasons is one of the highest in Europe. During the global economic crisis of 2008, the restrictive policies concerning access to healthcare and the quality of these services, which differs widely throughout the country, may have accentuated the territorial differences in unmet needs, thereby penalizing the more disadvantaged segments of the population. The study aimed at evaluating the geographical and socioeconomic differences, in particular the risk of poverty, that influence forgoing healthcare services in Italy.
Cross-sectional Italian data from the 2004-2015 European Survey on Income and Living Conditions (EU-SILC) were used. Hierarchical logistic models were tested, using as the outcome unmet needs for medical examinations or treatment in the preceding 12 months, and as risk factor the condition of being at risk of poverty. Age, sex, citizenship, educational level, presence of chronic or severely limiting diseases and self-perceived health were used as adjustment factors. Analyses were stratified over three time periods: pre-crisis (2004-2007), initial phase of the crisis (2008-2012) and second phase of the crisis (2013-2015).
In Central Italy and particularly in Southern Italy, a marked increase (9.9% in 2013-2015) was seen in the overall rate of unmet needs as well as in that of unmet needs due to economic reasons. The probability of unmet needs was higher, and increased over time, for those at risk of poverty (aOR = 1.54 in 2004-07, aOR = 1.70 in 2008-12, aOR = 2.21 in 2013-15). Individuals with a low educational level, who had a chronic or severely limiting disease, who perceived their health as not good and immigrants had a higher risk of forgoing healthcare. The regions in Southern Italy had a significantly higher probability of unmet needs.
A strong association was found between the probability of forgoing medical examination or treatment and being at risk of poverty. Study results underline the need for healthcare policies aimed at facilitating access to healthcare services, particularly in the South, by developing a progressive mechanism of contribution to healthcare costs proportional to income and by guaranteeing free access to the poor.
在意大利，因经济原因而放弃医疗检查或治疗的人数是欧洲最高的国家之一。在 2008 年全球经济危机期间，有关获得医疗保健的限制政策和服务质量（在全国范围内差异很大）可能加剧了未满足需求的地区差异，从而使人口中的弱势群体受到惩罚。本研究旨在评估地理和社会经济差异，特别是贫困风险，这些因素会影响意大利放弃医疗保健服务的情况。
使用 2004-2015 年欧洲收入和生活条件调查（EU-SILC）的意大利横截面数据。使用分层逻辑模型作为因变量，检验了在过去 12 个月中未满足医疗检查或治疗需求的情况，并将处于贫困风险状态作为风险因素。年龄、性别、公民身份、教育水平、是否患有慢性或严重限制疾病以及自我感知的健康状况被用作调整因素。分析分为三个时间段：危机前（2004-2007 年）、危机初期（2008-2012 年）和危机后期（2013-2015 年）。
在意大利中部和特别是南部地区，由于经济原因而未满足需求的总体比率以及未满足需求的比率都明显增加（2013-2015 年为 9.9％）。处于贫困风险中的人未满足需求的可能性更高，并且随着时间的推移而增加（2004-07 年的优势比[aOR]=1.54，2008-12 年的 aOR=1.70，2013-15 年的 aOR=2.21）。教育水平较低、患有慢性或严重限制疾病、自我感知健康状况不佳和移民的人更有可能放弃医疗保健。意大利南部地区未满足需求的可能性明显更高。
发现放弃医疗检查或治疗的可能性与处于贫困风险之间存在很强的关联。研究结果强调需要制定医疗保健政策，旨在通过制定与收入成比例的医疗保健费用累进缴纳机制，并确保穷人免费获得医疗保健，来促进南部地区特别是南部地区获得医疗保健服务。
