Journal Article

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

Pianori, Davide, Maietti, Elisa, Guicciardi, Stefano, Lenzi, Jacopo, Quargnolo, Mattia, Adja, Kadjo Yves Cedric, Toth, Federico, Fantini, Maria Pia

2020

Overview

Although Italy's NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector. Data were retrieved from the national Istat survey \"Health conditions and use of health services\" carried out in 2012-2013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis. Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%). The attitude of the population to use private services for specialist visits is linked both to sociodemographic and health services organizational factors: the former are unmodifiable while the latter are susceptible to managerial and health policy actions. In a public-financed, universal coverage system, policy makers may act upon the organizational factors that make private health facilities more attractive in order to reduce private care use.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adults / Attitudes / Cardiology / Chi-square test / Chronic illnesses / Demographic aspects / Economic resources / Educational attainment / Exemption / Expenditures / Finance / Gynecology / Health behavior / Health care / Health care expenditures / Health care facilities / Health care industry / Health care policy / Health care reform / Health policy / Health services / Management / Medical care utilization / Medical law / Medical specialties / Medicine and Health Sciences / Mental health services / Obstetrics / Ophthalmology / Organizational aspects / Organizational factors / Orthopedics / Outpatient care facilities / Patients / People and Places / Physicians / Policy making / Polls & surveys / Private sector / Public health administration / Public sector / Public services / Questionnaires / Reason / Regression analysis / Services / Social Sciences / Social services / Socialized medicine / Sociodemographics / Statistical tests / Taxation / Time