Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 26;10(3):449.
doi: 10.3390/healthcare10030449.

Vertical Equity in Healthcare Financing: A Progressivity Analysis for the Italian Regions

Guido Citoni  1 , Domenico De Matteis  2 , Margherita Giannoni  3   4
Affiliations

Vertical Equity in Healthcare Financing: A Progressivity Analysis for the Italian Regions

Guido Citoni et al. Healthcare (Basel). .

Abstract

Background: The aim of this paper is to measure for the first time in Italy the progressivity of healthcare financing systems at the regional level by using the Kakwani index (KI), the most widely used summary measure of progressivity in the healthcare financing literature.

Methods: KIs were reported by region and by health financing sources for the year 2015.

Results: There were significant vertical inequities in healthcare financing at both national and regional level. OOP (out-of-pocket) payments and value added tax were slightly regressive; income taxation on firms and households was progressive.

Conclusions: After the introduction of fiscal federalism during the 90s, the healthcare financing system became regressive. A regional divide emerged: Overall regressivity is higher in the south and lower in the north, partly compensated by the interregional equalization mechanism, based on the redistribution of VAT from northern to southern regions. In times of policy interventions aiming at recovering the economy during the COVID-19 pandemic, it is important to monitor equity in healthcare financing.

Keywords: equity in healthcare financing; progressivity; vertical equity.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall progressivity at national and regional levels—Italy, 2015 (regional weighted Kakwani Index). Source: Authors’ estimates based on Italian National Institute of Statistics household budget survey [25] and IT-SILC survey data [26]. Weighted Kakwani indices. All results are statistically different from zero at the 5% level of significance.
See this image and copyright information in PMC

References

    1. Wagstaff A., van Doorslaer E. Equity in the finance of health care: Some international comparisons. J. Health Econ. 1992;11:361–387. doi: 10.1016/0167-6296(92)90012-P. - DOI - PubMed
    1. Kakwani N.C. Measurement of tax progressivity: An international comparison. Econ. J. 1977;87:71–80. doi: 10.2307/2231833. - DOI
    1. Citoni G. Distribuzione dei costi di finanziamento dei servizi sanitari. In: France G.G., Attanasio E., editors. Economia Sanitaria: Linee e Tendenze di Ricerca in Italia. Giuffré; Milano, Italy: 1993.
    1. Wagstaff A., Van Doorslaer E., Van der Burg H., Calonge S., Christiansen T., Citoni G., Gerdtham U.G., Gerfin M., Gross L., Häkinnen U., et al. Equity in the finance of health care: Some further international comparisons. J. Health Econ. 1999;18:263–290. doi: 10.1016/S0167-6296(98)00044-7. - DOI - PubMed
    1. Bordignon M., Turati G. Bailing out expectations and public health expenditure. J. Health Econ. 2009;28:305. doi: 10.1016/j.jhealeco.2008.12.008. - DOI - PubMed

LinkOut - more resources