Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance

In the Italian NHS, over the last decades, a growing share of population opted for a Voluntary Health Insurance (VHI) in order to privately access healthcare services and bypass the increasingly long waiting times of the public system. The study analyses whether and to what extent the presence of a VHI may condition the choice of privately accessing healthcare services. Information on different access fees, specifically “full price”, “copayment price” and “no price”, are furnished for both specialist visits and diagnostic tests; the analysis is focused on these services. Data is drawn from the European Health Interview Survey, and is modelled through Propensity Score Matching to find possible differences in the choice of accessing private, rather than public, healthcare services by individuals with VHI. Results show a higher likelihood of accessing private specialist (+7.3 %) and diagnostic care (+7.3 %) by patients with a VHI compared to patients without VHI; conversely, having a VHI decreases the probability of seeking NHS care, through copayment, by respectively 5.1 % and 6.3 %. These findings suggest that the spread of VHI may reduce the burden on the NHS and increase the availability of diagnostic and specialist services for patients without integrative coverage. On the other side, the analysis shows that income, education and employment status are directly related to the probability of having a VHI, raising concern on possible inequalities across socioeconomic classes in the access to healthcare services. Policy implications are not univocal and claim for a deeper insight into these aspects by both scholars and policymakers.