The idea that private health expenditure compensates for the poor quality of public health is unfounded. The private expenditure of Italian families for health is in fact more linked to their income than to the low quality level of the regional public health systems. This is what emerges from the first results of the Observatory on private consumption in healthcare of SDA Bocconi (OCPS), presented today at Bocconi.
Private health expenditure by families, the so-called out-of-pocket expenditure, amounted to almost 2011 billion euro in 28, 20% of total health expenditure in Italy (140 billion euro) and in that year accounted for 4% of total household spending. Analyzing the regional differentials in per capita private expenditure, the analysis conducted by the Observatory highlighted how the amount of private health expenditure is positively correlated more with per capita income than with the low quality of public health systems. The ranking of per capita private spending shows how Trentino Alto Adige is in the top positions, with 707 euros per capita in 2011, Veneto with 666 euros, Friuli with 588 and Emilia-Romagna with 564. At the bottom of the ranking is Sardinia, with 350 euros per capita of private spending, Basilicata (325), Sicily (289) and Campania (239).
"The idea that regional differentials in private spending are essentially the result of differentials in the functioning of public systems finds little evidence," explains Mario Del Vecchio, director of the Observatory. "The data show how the southern regions, which could hardly be considered as the best in the national context, are also those in which private healthcare is spent the least".
The OCPs analysis then focused on the study of the behavior of Italian families with regard to private healthcare consumption, which made it possible to identify four different clusters. The first is that of families who spend little, with an average of 68,8 euros per month per family and 15,5 euros per capita. They represent 79% of the sample, but only 27% of private health expenditure. The second cluster is that of those who spend a lot on dental expenses alone: around 535 euros per month per family on average, 171 per capita. They are 4% of the sample and are worth 17% of the expenditure. The third represents the families that spend on illness, 15% of the sample and 36% of the total expenditure, with 257 euros spent per family and 96 per capita. Finally, the cluster of those who spend the most, i.e. families in search of well-being, who are 2% but represent 20% of spending. Their expenditure amounts to an average of 1.071 euros per month per family, 396 per capita.
Your region affects who spends at the dentist and who spends on wellness. In fact, almost 50% of the families belonging to the cluster that spends on the dentist reside in just 4 regions (Piedmont, Veneto, Lombardy, Trentino), while 30% of the families in the cluster wellness research lives in Lombardy, Veneto and Piedmont.
Be careful though, if it is true that at a macro level private expenditure appears to be correlated to income, in the detail of families those who spend a lot on the dentist or on their own well-being are not necessarily rich: 40% of cluster 2 is made up of couples with 1 or 2 children, while 36% of cluster 4 is represented by people over 65 and 34% by families with children.
“It is generally thought that private expenditures related to well-being are only luxuries,” adds Del Vecchio. “This cluster, on the other hand, includes many people with important pathologies who spend, alongside public spending, to improve their quality of life”.
Another aspect that the survey shed light on is how diversified the parameters for choosing the structures are based on the type of services. Waiting times, for example, are considered important for dermatological or pediatric visits, but not for eye visits. Proximity, then, is relevant for laboratory analyzes or physiotherapy, but not for diagnostic imaging. The convenience of the price, on the other hand, matters only for some categories of services, such as parapharmacy, optics or for social-health services, while it generally appears more significant (both as an average and as a number of services for which it is considered relevant) transparency in the price.
