Public–private mix in healthcare: access for whom? Theory, empirics and data gaps

This dissertation examines the role of the private sector in universal public healthcare systems. Through three interconnected studies, it critically assesses the claim that increasing private healthcare utilization can ease pressure on the public sector. A probabilistic voting model and cross-country European evidence indicate that higher private health insurance, often incentivized by tax deductions, does not lead to improved access for public patients. Microdata analysis from Italy (2017–2022) further reveals that higher private healthcare expenditure is associated with a greater risk of unmet medical needs among low-income individuals. Finally, a systematic review highlights major data gaps and inconsistencies in measuring unmet needs and private health financing, limiting policy evaluation. Together, the studies demonstrate that private sector development does not automatically benefit public systems and emphasize the need for robust data frameworks to support evidence-based health policy.