An Assessment of Effects of Socioeconomic Status, Employment Type, and Employee Benefits on Italian Healthcare Access and Delivery in Milan.

An Assessment of Effects of Socioeconomic Status, Employment

Type, and Employee Benefits on Italian Healthcare Access and Delivery in Milan

Survey

Italian Translation

14

16FM

Survey Sample

20-30 30-40 40-50 50-60 60-700

1

2

3

4

5

6

7

8

9

10

9

7

4

6

4

Sample Pool by Age Group

Government Private Sector Self Employed0

2

4

6

8

10

12

14

16

18

20

7

19

4

Survey Sample Pool

a. Less than 500

b. 500-1000

c. 1000-1500

d. 1500-2000

e. 2000-2500

f. 2500-3000

g. 3000-3500

h. 3500-4000

i. Over 4000

0

1

2

3

4

5

6

7

8

9

10

3

5

9

3

1 1

4

2 2

Sample Pool by Income Level

a. Less than 500

b. 500-1000 c. 1000-1500

d. 1500-2000

e. 2000-2500

f. 2500-3000 g. 3000-3500

h. 3500-4000

i. Over 40000

0.5

1

1.5

2

2.5

3

3.5

1 1

2

1

2

3 3

1 11 1

2 2

1 1

2

1

2

1 1

Income vs. EducationAssociate's

Bachelor's

Doctorate

High School

High School

Master's

Research Results

Quality of Care

0

5

10

15

20

25

30

6

9

13

7

24

21

16

23

1

Quality of CareNo

Yes

No Answer

Satisfied with Primary Care Physician Choices?

Satisfied with Specialists Choices?

Broad Range of Services Offered?

Time Spent Adequate?0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

20%

30%

43%

23%

80%

70%

53%

77%

Quality of Care

No Yes

Access to Care

Primary Physician Care Specialist Care Diagnostic Tests0

5

10

15

20

25

23

2120

7

9

10

Access to CareChallenges Faced While Seeking?

No Yes

Primary Physician Care Specialist Care Diagnostic Tests0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

77%

70%67%

23%

30%33%

Access to CareChallenges Faced While Seeking:

No Yes

Wait Period for Physician Appointment: Average: 11.94 days Max: 90 days Min: 0 days

Wait Period in Physician’s Clinic: Average: 2.52 hours Max: 12 hours Min: 30 minutes

Access to Care

Cost of Care

Out of Pocket Pay? Out of Pocket Pay Significant?0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

41%

76%

59%

24%

Cost of CareNo Yes

Opinions on Insurance Systems

Satisfied with Public Insurance? Purchase Private if More Options?0%

10%

20%

30%

40%

50%

60%

70%

80%

27%

53%

73%

47%

Insurance OptionsNo Yes

Major Observations:In Conjunction with Income

Levels

A greater number of individuals with monthly incomes lower than €2000 thought that public health insurance did not provide a broad range of services than did individuals with monthly incomes higher than €2000 (29.17% vs. 15.56%)

Quality of Care

A greater number of individuals with monthly incomes lower than €2000 faced challenges in seeking primary physician care than did individuals with monthly incomes higher than €2000 (13.33% vs. 8.89%)

A greater number of individuals with monthly incomes lower than €2000 faced challenges in seeking specialist care than did individuals with monthly incomes higher than €2000 (21.67% vs. 8.89%)

A greater number of individuals with monthly incomes lower than €2000 faced challenges in seeking diagnostic tests than did individuals with monthly incomes higher than €2000 (25% vs. 10%)

Access to Care

Individuals with monthly incomes lower than €2000 spent SIGNIFICANTLY more time on an average waiting for a physician’s appointment than did individuals with monthly incomes higher than €2000 (10.9 days vs. 1.43 days)

Individuals with monthly incomes lower than €2000 spent SIGNIFICANTLY more time on an average waiting their appointment at the doctor’s clinic than did individuals with monthly incomes higher than €2000 (2.23 vs 0.44 hours or 134 vs. 27 minutes)

Access to Care

A greater number of individuals with monthly incomes lower than €2000 made out of pocket contributions to healthcare than did individuals with monthly incomes higher than €2000 (45.85% vs. 13.33%)

These out of pocket contributions were more likely to represent a significant portion of the take-home income for individuals with monthly incomes lower than €2000 than for individuals with monthly incomes higher than €2000 (16.67% vs. 0%)

Cost of Care

A greater number of individuals with monthly incomes lower than €2000 were satisfied with the public health insurance system than were individuals with monthly incomes higher than €2000 (50% vs. 24.44%)

A greater number of individuals with monthly incomes lower than €2000 were open to purchasing private insurance if it translated to more coverage options and more efficient care than were individuals with monthly incomes higher than €2000 (26.67% vs. 17.78%)

Opinions on Health Insurance Systems

“We don’t have insurance here.”

“I would be willing to buy [private] health insurance only if I wouldn't deposit [more] money to the state, as the taxes that I pay are much more than enough. Unfortunately, [not purchasing one] affects our [healthcare options].”

“[Our system] doesn't [allow you to see the same] professional doctor for specialist care. [Therefore, there is] discomfort with the continuity of care.”

Additional Comments

Regional Disparity High quality service within public healthcare

framework in the North Not the same story in the South, hence push for

private coverage

Non-emergency care wait times long across the nation Example: cataract surgery wait times around 9-12

months

Interview w/ Dr. Stefano Rusconi

Some Pictures