Assessing health status inequality. an empirical analysis for italian regions

Health inequalities are a growing concern in the public health debate in Italy as well as in Europe, also considering the profound differences occurred between territories during the period of the Covid-19 epidemic (Blundell et al. 2020). In Italy, article 32 of the Constitution states that “The Republic protects health as a fundamental right of the individual and in the interest of the community and it guarantees free care to the indigent”. The concept of health therefore has a twofold meaning: it is a fundamental right of the individual relating to his/her private sphere, but it is also qualified as an interest of the community. Despite the relevance given to health protection in the Constitutional text, in Italy the related health care system was very patchy, and it was based on the occupational welfare model until the mid-1970s. Health care was basically reserved for workers with benefits differentiated by economic sectors and professional categories. About 90% of the population (workers and their families) were covered by health care with benefits varying among categories of workers and with about 3 million people uninsured (Ricciardi and Tarricone 2021). Despite the various reforms aimed at ensuring uniformity of health and health services, territorial differences still persist. In this regard, we propose a new composite regional health status indicator highlighting the variability of health status between 21 territorial units (19 regions and 2 autonomous provinces). Relying on the Diderichsen’s model, we introduce a conceptual framework explaining the socio-economic and policy determinants of the health status inequalities and we then provide empirical evidence of these determinants for Italian regions. We also analyse cross-country variability in health status deriving statistically significant associations between the composite indicator and socio-economic and policy variables. We find that the efficiency of regional healthcare systems and the quantitative and qualitative characteristics of the services and assistance have a positive effect on health status. Moreover, the public or private nature of the healthcare services' provision is an explanatory factor for regional health differences. In particular, the prevalence of public healthcare services is associated to good health status.