Department of Economics and Law, Sapienza-University of Rome, Via del Castro Laurenziano 9, 00161, Rome, Italy.
Eur J Health Econ. 2022 Jun;23(4):671-685. doi: 10.1007/s10198-021-01388-9. Epub 2021 Oct 27.
In Italy, the COVID-19 pandemic and the death of many elderly people have put in evidence the uneven territorial distribution of nursing homes, which have amplified the spread and severity of the pandemic. By applying a pooled OLS model to the Italian regions, over the 2010-18 period, we investigate the demand factors, market forces and institutional drivers of the spatial distribution of residential healthcare for the elderly. Using a fine-grained approach that considers specific regional and age-related elements and the market environment, which can reduce or increase the pressure on regional governments to provide formal assistance, we find that the financial resources and the availability of unemployed women as potential caregivers explain the distribution of expenditure better than the health needs of the elderly. As a result, the expenditure is concentrated in richer and more financially autonomous regions and it is not congruent with the distribution of chronicity, health and frailty factors or income among the elderly. These critical issues of the care services for frail elderly people, related to a highly decentralized governance and resulting in fragmented, market-driven provision, could be attacked only by a national reform.
在意大利，COVID-19 大流行和许多老年人的死亡暴露了养老院在地域分布上的不均衡，这加剧了大流行的传播和严重程度。通过在意大利地区应用 pooled OLS 模型，我们在 2010-18 年期间调查了老年人居住医疗保健的空间分布的需求因素、市场力量和制度驱动因素。我们采用了一种精细的方法，考虑了特定的区域和年龄相关因素以及市场环境，这可以减轻或增加地区政府提供正式援助的压力，我们发现财政资源和失业妇女作为潜在护理人员的可用性比老年人的健康需求更能解释支出的分布。因此，支出集中在更富裕和更具有财政自主性的地区，这与老年人的慢性病、健康和脆弱因素或收入分布不一致。这些与高度分散的治理相关的脆弱老年人护理服务的关键问题导致了分散的、以市场为导向的服务提供，只有通过国家改革才能解决。
