Int J Health Geogr - Geographical variation of unmet medical needs in Italy: a multivariate logistic regression analysis.

Tópicos

{ health(3367) inform(1360) care(1135) }
{ care(1570) inform(1187) nurs(1089) }
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Resumo

CKGROUND: Unmet health needs should be, in theory, a minor issue in Italy where a publicly funded and universally accessible health system exists. This, however, does not seem to be the case. Moreover, in the last two decades responsibilities for health care have been progressively decentralized to regional governments, which have differently organized health service delivery within their territories. Regional decision-making has affected the use of health care services, further increasing the existing geographical disparities in the access to care across the country. This study aims at comparing self-perceived unmet needs across Italian regions and assessing how the reported reasons - grouped into the categories of availability, accessibility and acceptability - vary geographically.METHODS: Data from the 2006 Italian component of the European Union Statistics on Income and Living Conditions are employed to explore reasons and predictors of self-reported unmet medical needs among 45,175 Italian respondents aged 18 and over. Multivariate logistic regression models are used to determine adjusted rates for overall unmet medical needs and for each of the three categories of reasons.RESULTS: Results show that, overall, 6.9% of the Italian population stated having experienced at least one unmet medical need during the last 12 months. The unadjusted rates vary markedly across regions, thus resulting in a clear-cut north-south divide (4.6% in the North-East vs. 10.6% in the South). Among those reporting unmet medical needs, the leading reason was problems of accessibility related to cost or transportation (45.5%), followed by acceptability (26.4%) and availability due to the presence of too long waiting lists (21.4%). In the South, more than one out of two individuals with an unmet need refrained from seeing a physician due to economic reasons. In the northern regions, working and family responsibilities contribute relatively more to the underutilization of medical services. Logistic regression results suggest that some population groups are more vulnerable than others to experiencing unmet health needs and to reporting some categories of reasons. Adjusting for the predictors resulted in very few changes in the rank order of macro-area rates.CONCLUSIONS: Policies to address unmet health care needs should adopt a multidimensional approach and be tailored so as to consider such geographical heterogeneities.

Resumo Limpo

ckground unmet health need theori minor issu itali public fund univers access health system exist howev seem case moreov last two decad respons health care progress decentr region govern differ organ health servic deliveri within territori region decisionmak affect use health care servic increas exist geograph dispar access care across countri studi aim compar selfperceiv unmet need across italian region assess report reason group categori avail access accept vari geographicallymethod data italian compon european union statist incom live condit employ explor reason predictor selfreport unmet medic need among italian respond age multivari logist regress model use determin adjust rate overal unmet medic need three categori reasonsresult result show overal italian popul state experienc least one unmet medic need last month unadjust rate vari mark across region thus result clearcut northsouth divid northeast vs south among report unmet medic need lead reason problem access relat cost transport follow accept avail due presenc long wait list south one two individu unmet need refrain see physician due econom reason northern region work famili respons contribut relat underutil medic servic logist regress result suggest popul group vulner other experienc unmet health need report categori reason adjust predictor result chang rank order macroarea ratesconclus polici address unmet health care need adopt multidimension approach tailor consid geograph heterogen

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