Background: During the 1990s, Italy underwent significant changes in its National Health System including decentralization of health policy responsibilities to regional administrations, introduction of internal markets and increasing, in some regions, of the private sector role in delivering healthcare. We compared the effectiveness of private- and public-sector healthcare expenditure on avoidable mortality (deaths that should not occur in the presence of effective medical care). Methods: We calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy’s regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of public versus private healthcare expenditure, controlling for potential demographic and economic confounders. Results: Greater per capita spending on public delivery of health services corresponded to higher reductions in avoidable mortality rates. Per capita private health expenditure had no effect on avoidable mortality in most regions and was associated with less progress in reducing avoidable mortality in other ones. After correcting for differences in each region’s per capita income, we found that 10% additional public spending on National Health Service delivery was associated with a 3.1% reduction in avoidable mortality rate (p<0.001). Private health expenditure, by contrast, had no statistically significant effect on avoidable mortality rates (p = 0.489). A higher private health expenditure as percentage of the total health expenditure was associated with higher avoidable mortality (p<0.001). As a control exercise, we found that neither public nor private healthcare spending was significantly associated with non-avoidable mortality, plausibly because non-avoidable mortality is less sensitive to healthcare services. Conclusion: Public healthcare delivery was significantly associated with greater progress in reducing avoidable mortality rates, whereas private spending related to less progress in reducing avoidable mortality across time in Italy’s regions. Public National Health Service delivery may be more likely to achieve better overall population healthcare performance than private sector delivery.

Quercioli, C., Messina, G., Basu, S., Mckee, M., Nante, N., & Stuckler, D. (2012). The Effect of Health Care Delivery Privatization on Avoidable Mortality: Longitudinal Cross-Regional Results from Italy, 1993-2003. JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 67(2), 132-138.

The Effect of Health Care Delivery Privatization on Avoidable Mortality: Longitudinal Cross-Regional Results from Italy, 1993-2003

MESSINA, GABRIELE;NANTE, NICOLA;
2012

Abstract

Background: During the 1990s, Italy underwent significant changes in its National Health System including decentralization of health policy responsibilities to regional administrations, introduction of internal markets and increasing, in some regions, of the private sector role in delivering healthcare. We compared the effectiveness of private- and public-sector healthcare expenditure on avoidable mortality (deaths that should not occur in the presence of effective medical care). Methods: We calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy’s regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of public versus private healthcare expenditure, controlling for potential demographic and economic confounders. Results: Greater per capita spending on public delivery of health services corresponded to higher reductions in avoidable mortality rates. Per capita private health expenditure had no effect on avoidable mortality in most regions and was associated with less progress in reducing avoidable mortality in other ones. After correcting for differences in each region’s per capita income, we found that 10% additional public spending on National Health Service delivery was associated with a 3.1% reduction in avoidable mortality rate (p<0.001). Private health expenditure, by contrast, had no statistically significant effect on avoidable mortality rates (p = 0.489). A higher private health expenditure as percentage of the total health expenditure was associated with higher avoidable mortality (p<0.001). As a control exercise, we found that neither public nor private healthcare spending was significantly associated with non-avoidable mortality, plausibly because non-avoidable mortality is less sensitive to healthcare services. Conclusion: Public healthcare delivery was significantly associated with greater progress in reducing avoidable mortality rates, whereas private spending related to less progress in reducing avoidable mortality across time in Italy’s regions. Public National Health Service delivery may be more likely to achieve better overall population healthcare performance than private sector delivery.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11365/41177
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