Regional Inequities in the Distribution of the Nursing Workforce in Italy

Abstract

Background/Objectives: Inequalities in access to nursing professionals represent a significant challenge to achieving equity in healthcare systems. In decentralized countries like Italy, disparities in the distribution of nurses persist despite a universal national health system. This study investigates the extent and determinants of regional inequality in the distribution of the nursing workforce in Italy. Methods: A retrospective ecological analysis was conducted using administrative data from official national sources (ISTAT, Ministry of Health) concerning the number of nurses and population per region, along with Human Development Index (HDI) data from 2021. Descriptive statistics, the Gini coefficient, Lorenz curve, and Pearson correlation were used to assess inequality and identify influencing factors. Results: The national Gini coefficient was 0.136, indicating a moderate degree of inequality in the distribution of nurses across Italian regions. A strong positive correlation was observed between HDI and nurse-to-population ratio (r = 0.76, p < 0.001), suggesting that more developed regions have higher nursing density. Conclusions: Despite a universal healthcare system, Italy shows persistent regional disparities in nurse distribution. These findings emphasize the need for targeted policies and coordinated planning to reduce inequalities and ensure equitable access to nursing care across all regions.

Keywords: Gini coefficient; Human Development Index; equity; nursing workforce; regional disparities.

Figure 1

Lorenz curve relative to the general distribution of nurses in the Italian regions.

Figure 2

Lorenz curve of the distribution of nurses by regional groups according to Human Development Index (HDI).