Chapter 2

4.1 - Equity in the italian healthcare
system: impoverishment and catastrophic
payments
Doglia M. 1 , Spandonaro F. 2
4.1.1 Introduction
The Italian national health system (INHS) takes the form of a universal social insurance:
this imply that, not only, should be able to promote citizen’s well being, but also to avoid
any relevant economic burden on the households with ill members.
The World Health Organization (WHO) proposed to integrate the classical (ex ante) equity
approach with measures in the so-called burden space. This is an “ex-post” evaluation
made comparing households out of pocket health expenditures with their capacity to
pay.
The burden space measures in fact can help to understand how well the INHS protects
citizens from the economic risk of illness.
The present contribution analyses, particularly, impoverishment and catastrophic payments
phenomenon, as they results very useful in assessing household fragility.
4.1.2 Databank and methodology
Referring to bibliography for technicalities, we only observe that the WHO approach has
been taught for a worldwide use; in the present contribution, we have tried to adapt it to
the specific situations of a developed country such as Italy. Therefore we have considered
the absolute poverty threshold published by the Italian Institute for Statistics (ISTAT)
to evaluate the paying capacity of households, as well as the ISTAT relative poverty threshold
for assessing impoverishment.
According to the WHO approach, the household capacity to pay has been evaluated from
the effective standardized non-subsistence consumption level.
Moreover, we have chosen to focus our attention only on impoverishment and catastrophic
payment as we feel that these are the most delicate issues. They can indicate both
a failure in the social security mechanism, or an implicit incentive for opting out of the
system, due to the relevant economic burden born by some households.
One of the major shortcomings of this approach is its sensitivity to the choice of thresholds
(especially for catastrophic payments): so we have elaborated both, the point level
1 ISTAT National Statistical Institute, Italy.
2 CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata” .
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CEIS Health Report 2006