abstract: 'Background: 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.'
affiliation: 'Cavalieri, M (Corresponding Author), Univ Catania, Dept Econ \& Business,
  Corso Italia 55, I-95129 Catania, Italy.

  Univ Catania, Dept Econ \& Business, I-95129 Catania, Italy.'
article-number: '27'
author: Cavalieri, Marina
author-email: mcavali@unict.it
author_list:
- family: Cavalieri
  given: Marina
da: '2023-09-28'
doi: 10.1186/1476-072X-12-27
files: []
issn: 1476-072X
journal: INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS
keywords: 'Italy; Unmet health care needs; Access to health care; Barriers to

  health care; Decentralization'
keywords-plus: HEALTH-CARE-SYSTEM; SERVICES; ACCESS; USERS
language: English
month: MAY 12
number-of-cited-references: '29'
orcid-numbers: Cavalieri, Marina/0000-0002-2294-5588
papis_id: 0bb06556813888fa324e20e887d2173c
ref: Cavalieri2013geographicalvariatio
times-cited: '53'
title: 'Geographical variation of unmet medical needs in Italy: a multivariate logistic
  regression analysis'
type: article
unique-id: WOS:000319429100001
usage-count-last-180-days: '0'
usage-count-since-2013: '10'
volume: '12'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2013'