Ricerc@Sapienza

Vertical equity in health care financing in European countries has been considered a growing concern starting from the early 90s. Evidence for Italy showed that at the beginning of the 90s the overall degree of progressivity was mildly positive (Wagstaff et al., 1999). Italy¿s health care system has been reformed several time, particularly introducing in 1996 fiscal federalism in health care financing and with legislative decree n.56/2000. This increased regional variability in both financing and expenditure. Particularly, there has been an increase in regional variations for the share of health care expenditure on total household expenditure. There is evidence that this process introduced an increase in horizontal income-related inequities in health and health care utilization both at comparative European level at regional level within Italy. However, regarding vertical equity, there is the need of reevaluating the issue and of updating the analysis.

Objective
The aim of this paper is to measure the progressivity in health care financing at regional level in Italy. There are three distinct stages for an analysis of progressivity. First, to establish the progressivity of each source of finance. Second, to establish the overall progressivity of the system. Third, to establish overall progressivity for each region (O¿Donnell et al., 2008).

Methodology
We opt to use the Kakwani index (Kakwani 1977). This is the most widely used summary measure of progressivity in both the tax and the health finance literatures.

Data
We use cross-sectional data from the Italian National Institute of Statistics households budget survey for the year 2015. Moreover, regional level data from Istat Regional Accounts are used in order complement the analysis.

Results
First results show that there are regional inequalities in health care financing. The Kakwani index for out-of-pocket and private insurance is slightly progressive, whereas for drugs and specialist care is regressive.