Health and Health Care Utilization of Vulnerable Groups. a Comparative Study between Italy and France

Eleonora Trappolini, Sapienza University of Rome
Cristina Giudici, Sapienza University of Rome

The mortality profiles of Italy and France look very similar, conversely their causes of death are different. By a comparative approach, the study aims to analyze inequalities in the health status and the health service utilization of the disadvantaged categories in Italy and France. Taking into account such disparities, together with the social and economic context of these two Countries, this study could provide some hints to better understand the reasons behind the difference between the two cause-specific mortality patterns. Data come from the Italian Health Condition Survey (ISTAT-2013) and the French survey on Health and Health Care and Insurance (IRDES-2014). The analyses are conducted using logistic regression and the Heckman model is applied to account for sample selection for reducing the estimation bias. Preliminary findings show that health inequalities are related to age, sex, socio-economic position and place of birth.

During the last five decades, Europe has witnessed a tremendous improvement in health, resulting in the ever-increasing life expectancy, control of certain diseases and decline of early mortality, but these changes remained unequally distributed among different classes and countries.

Previous studies found that the mortality profiles of Italy and France look very similar, with countries specificities in terms of causes of death. Such specificities may reflect real differences in the morbid processes prevailing in the countries, or they may correspond to country-specific certifying and coding practices (Désesquelles et al. 2010). Exploring health inequalities in Italy and France, and looking at their specific social and economic context, could provide some better understanding of the reasons behind the difference in cause-specific mortality patterns between the two Countries.

Health inequalities are related to the different factors of morbidity, self-perceived health and the use of health services among the most vulnerable groups of the population.

As it is a complex phenomenon to deal with, the major objective of this work is to analyze the health status and the ‘care utilization’ of the disadvantaged categories in Italy and France. By applying a comparative approach, we want to verify how the social and political context could affect inequalities in health and mortality in these two countries.

The study is based on data from the 2013 wave of the Italian Health Condition Survey carried out by the Italian National Institute of Statistics, and the 2014 wave of the French survey on Health and Health Care and Insurance coordinated by the Institute for Research and Information in Health and Economics. Data are nationally representative of people living in private dwellings older than 15 years. The Italian sample focuses on 119,073 individuals; the French sample focuses on 26,514.

The surveys provide information about both demographic and socio-economic characteristics of individuals and households, as well as on perceived health status, lifestyle, living and working conditions, and health care utilization.

In our study, vulnerable groups involve individuals with disadvantages in the economic or socio-demographic sphere: population aged 60 and over, migrants, single-parent families, individuals who suffer from severe disabilities.

We use self-perceived health as dependent variable for studying the health condition, while the analysis of care utilization is based on four different dependent variables, one for each of the four typologies of access to health care: GP visits, specialist enaminations, prevention screenings, and ER care. The reference period was the last 4 weeks immediately prior to the interview. The number of visits was self-reported. For migrant groups, the main independent variable of interest is immigrant status defined according to both the place of birth and the citizenship criteria. We identified four categories: the native reference group; the first-generation of immigrants, as individuals born outside of Italy/France who did not have Italian/French citizenship; the second-generation of immigrants, as individuals born in Italy/France who did not hold Italian/French citizenship; naturalized Italians/French who are individuals born outside of Italy/France who have Italian/French citizenship. Another important variable in the study of ethnic groups is represented by the length of residence in the host country

The analyses are adjusted for socio-demographics characteristics, financial resources, kind of medical examinations and health behaviours.

Logistic regression helps to understand how being part of the selected vulnerable groups determine the health status, after controlling for a set of covariates.

On the other side, for analysing the access to health care services, we apply the Negative binomial model for dealing with over-dispersion. However, this model considers health utilization as a one process decision making; it is not possible to consider separately the contact decision from the frequency decision. The decomposition of the health care variable into two parts, to consider separately the users and the non-users, may implies unobserved heterogeneity. The Heckman model is employed to account for sample selection for reducing the estimation bias.

Furthermore, we will perform separate analyses for each of the frail categories, taking into account that in some cases they may overlap, in order to verify which factors affect the health care utilization.

From a first analysis, as expected, in both populations elderly are more prone to report health problems. Both in Italy and France, people with lower socio-economic conditions are more likely to report health problems. Depressive symptoms are the most common problem of mental health: in Italy, 4.3% of the population suffer from this problem; 7% among French people, mostly above 75 years old. Moreover, considering migrant population both in Italy and France they tend to use the healthcare services less than the reference population, because of several barriers. Due to financial problems, or even because the long waiting list, both in France and in Italy the number of people who have foregone medical visits is still increasing.

Presented in Session 1232: Posters