Assicurazioni sanitarie private: conseguenze per i cittadini e implicazioni per il SSN derivanti dalla loro eventuale introduzione. Un’opportunità o un vaso di Pandora?

Journal title MECOSAN
Author/s Maria Grazia Pirozzi, Sara Saggese
Publishing Year 2016 Issue 2015/95
Language Italian Pages 28 P. 109-136 File size 20384 KB
DOI 10.3280/MESA2015-095006
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The global economic downturn and the long-lasting economic stagnation due to the euro-zone crisis, placed at the center of attention the sustainability of the national health service (SSN). To reduce the financial burden on the public budget, policymakers and stakeholders proposed the introduction of private health insurances (ASPs) in the Italian health system as substitutive or complementary to the national health service. Starting from these assumptions, this work examines the ASPs as additional tools to support the national health system funding, and identifies their potential consequences to propose a model that describes the expected interactions SSN-ASP and the most prominent effects related to this scenario. The model is proposed as a framework for further studies and investigations.

Keywords: Health system, private health insurance, transaction costs, sustainability, fiscal equity, evidence based policy making.

  1. Associazione Europa 2020 (2014). La Sanità integrativa in Italia. Roma: Europa2020.
  2. Ania (2015). Fondi sanitari, la necessita di un riordino, disponibile al sito: www.ania.it/export/sites/default/it/pubblicazioni/Dossier-e-positionpaper/Fondi-sanitari-La-necessita-di-un-riordino-Position-Paper-23.06.2015.pdf.
  3. Armeni P., Ferre F. (2014). La spesa sanitaria: composizione ed evoluzione. Rapporto OASI 2014. Milano: Egea.
  4. Armeni P., Ferre F., Sommariva S. (2014). Il confronto dei sistemi sanitari in una prospettiva internazionale. Rapporto OASI 2014. Milano: Egea.
  5. Armeni P. (2011). La spesa sanitaria: composizione ed evoluzione. Rapporto OASI 2011. Milano: Egea. Arrow K.J. (1963). Uncertainty and the welfare economics of medical care. The American Economic Review, 53 (5): 851-883. DOI: 10.1215/03616878-26-5-851
  6. Bator F.M. (1958). The anatomy of market failure. The Quarterly Journal of Economics, 72 (3): 351-379. doi : 10.2307/1882231.
  7. Baumol W.J. (2012). The cost-disease: why computers get cheaper and health care doesn’t. New Haven: Yale University Press. DOI: 10.5860/CHOICE.50-4547
  8. Beaulieu N.D. (2002). Quality information and consumer health plan choices. Journal of Health Economics, 21 (1): 43-63. DOI: 10.1016/S0167-6296(01)00126-6
  9. Bennet N. (2014). Health concerns raised over EU-US trade deal. The Lancet, 384 (9946): 843-844. DOI: 10.1016/S0140-6736(14)61492-6
  10. Besley T., Hall J., Preston I. (1999). The demand for private health insurance: do waiting lists matter? Journal of Public Economics, 72 (2): 155-181. DOI: 10.1016/S0047-2727(98)00108-X
  11. Bontis N. (1999). Managing organizational knowledge by diagnosing Intellectual Capital: framing and advancing the state of the field. International Journal of Technology Management, 18 (5-8): 433-462. DOI: 10.1016/B978-0-7506-7475-1.50006-3
  12. Breuil-Genier P. (2000). Generaliste puis specialiste: un parcours peu frequent. INSEE Premiere, 709(Avril), disponibile al sito: www.insee.fr/fr/ffc/docs_ffc/IP709.pdf.
  13. Censis (2011). Affrontare il futuro. Le tutele sociali nell’Italia che cambia. Progetto Welfare Italia – Laboratorio per le nuove politiche sociali. Roma: UNIPOL-CENSIS.
  14. Censis (2013). Il ruolo della sanità integrativa nel servizio sanitario nazionale sintesi dei principali risultati. Roma: UNIPOL-CENSIS.
  15. Censis (2014). Integrare il welfare, sviluppare la white economy, Laboratorio per le nuove politiche sociali. Roma: UNIPOL-CENSIS.
  16. Censis (2015). Oltre l’attuale welfare integrativo: rinnovare la previdenza complementare e la sanità integrativa. Roma: UNIPOL-CENSIS.
  17. Chernew M.E., Gibson T.B. (2008). Cost Sharing and HEDIS Performance. Medical Care Research and Review, 65 (6): 713-729. DOI: 10.1177/1077558708319683
  18. Club The European House Ambrosetti (2013). L’evoluzione sostenibile della sanità in Italia. 7(50). Milano, disponibile al sito: www.ambrosetti.eu/wp-content/uploads/Lettera-Club-VIII-50-maggiu-2013_ITA.pdf.
  19. Commissione Europea (2015). Making the best use of the flexibility within the existing rules of the stability and growth pact, COM(2015) 12 final, disponibile in italiano al sito: http://eur-lex.europa.eu/legal-content/IT/TXT/PDF/?uri=CELEX :52015DC0012&from=EN.
  20. Consiglio Nazionale dell’Economia e del Lavoro (CNEL), Istituto nazionale di statistica (ISTAT) (2014). Rapporto sul benessere equo e sostenibile 2014. Roma. Testo disponibile al sito: http://www.istat.it/it/files/2014/06/Rapporto_Bes_2014.pdf.
  21. Gray J.A.M. (1997). Evidence-Based Healthcare: How to Make Health Policy and Management Decisions. London: Churchill Livingstone.
  22. Congress of the United States, Congressional Budget Office (1991). Rising health care costs: causes – implications and strategies. Washington D.C. Testo disponibile al sito: http://www.cbo.gov/sites/default/files/91-cbo-001.pdf (ultima consultazione 13 luglio 2015). Congress of the United States, Congressional Budget Office (1992). Economic implications of rising health care costs. Washington D.C. Testo disponibile al sito: https://www.cbo.gov/sites/default/files/1992-10_econimplication.pdf (ultima consultazione 13 luglio 2015).
  23. Corte dei Conti (2014). Relazione sulla gestione degli enti territoriali. Esercizio 2013. Deliberazione N. 29/SEZAUT/2014/FRG, Roma. Costa J., Garcia J. (2003). Demand for private health insurance: how important is the quality gap? Health Economics, 12 (7): 587-599. DOI: 10.1002/hec.756
  24. Council of the European Union (2006). Council conclusions on common values and principles in European health systems. Council of the European Union, Brussels. Testo disponibile al sito: http://eur-lex. europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:20 06:146:0001:0003:EN:PDF (ultima consultazione31 maggio 2015).
  25. maggio 2015).
  26. Cuser W.S. (2014). Quality of care metrics and health insurance. Journal of Financial Service Professionals, 68 (1): 30-32.
  27. Davies P. (2004). Is evidence-based government possible? Jerry Lee Lecture, presentato al 4th Annual Campbell Collaboration Colloquium, Washington DC, disponibile al sito: www.eldis.org/go/h o m e & i d = 1 8 7 0 5 & t y pe=Do cument # .Vh9ZXG7EJLP.
  28. Day B., Himmelstein D.U., Broder M., Woolhandler S. (2015). The Affordable Care Act and Medical Loss ratios: No impact on first three years. International Journal of Health Services, 45 (1): 127-131. doi : 10.2190/HS.45.1.i.
  29. Del Vecchio M., Fenech L., Mallarini E., Rappini V. (2014). I consumi privati in sanità. Rapporto OASI 2014. Milano: EGEA.
  30. Di Mascio F., Natalini A. (2015). Fiscal Retrenchment in Southern Europe: Changing patterns of public management in Greece, Italy, Portugal and Spain. Public Management Review, 17(1): 129-148. DOI: 10.1080/14719037.2013.790275.
  31. doi : 10.1080/14719037.2013.790275.
  32. Dirindin N. (1996). Chi paga per la salute degli italiani? Bologna: il Mulino.
  33. European Commission (2007). Directive on services in the internal market. Brussels. Testo disponibile al sito: http://ec.europa.eu/internal_market/services/services-dir/index_en.htm (ultima consultazione 31 maggio 2015).
  34. Ferre F., de Belvis A.G., Valerio L., Longhi S., Lazzari A., Fattore G., Ricciardi W., Maresso A. (2014). Italy: Health System Review. Health Systems In Transition. European Observatory on Health Systems and Policies, 16(4), disponibile al sito: www.euro.who.int/__data/assets/pdf_file/0003/263253/HiT-Italy.pdf.
  35. France Cour des Comptes (2008). La Sécurité Sociale. Rapport Public, La Documentation francaise. Testo disponibile al sito: http://www.ladocumentationfrancaise. fr/var/storage/rapportspublics/084000597.pdf (ultima consultazione 31 maggio 2015).
  36. 084000597.pdf (ultima consultazione 31 maggio 2015).
  37. Fuchs B. (1993). Health care reform: single-player approaches. Washington, D.C. Congressional Research Service: The Library of Congress. Gabriele S. (2012). Politiche recessive e servizi universali: il caso della sanita. In: Cesaratto S. e Pivetti M. (a cura di). Oltre l’austerità. Roma: Micromega. Gabriele S., Raitano M. (2009). Invecchiamento, salute, spesa sanitaria e di cura in Italia. Studi e Note di Economia, 15 (3): 541-569.
  38. Goldsmith J.C. (1994). The illusive logic of integration. Healthcare Forum Journal, 37 (5): 26-31.
  39. Hafez-Afifi N., Busse R., Harding A. (2003). Regulation of Health Services. In: Harding A. Preker A.S. (a cura di). Private participation in health services. Washington DC: The World Bank.
  40. Hellander I. (2006). A review of data on the U.S. health sector. International Journal of Health Services, 36 (4): 787-802. DOI: 10.2190/E91E-U8JRPRMU-VXT6
  41. Hsiao W.C. (1995). Abnormal economics in the health sector. Health Policy, 32 (1-3): 125-139. DOI: 10.1016/0168-8510(95)00731-7
  42. Kahneman D., Tversky A. (2000). Choises, Values and Frames. New York: Cambridge University Press.
  43. Kahneman D. (2012). Pensieri lenti e veloci. Milano: Arnoldo Mondatori Editore.
  44. Kathawala Y., Elmuti D., Roszkowski C. (1993). Health care coverage and costs in small business: an exploratory study. Health Marketing Quarterly, 10(3-4): 179-193. DOI: 10.1300/J026v10n03_13
  45. Kathawala Y., Elmuti D. (1994). An empirical investigation of health care coverage and costs in US small businesses, Journal of Small Business Management, 32 (4): 61-72.
  46. Kelton S. (2007). An introduction to the health care crisis in America: how did we get here? Center for full employment and price stability, University of Missouri, Kansas City, USA. Testo disponibile al sito: http://www.cfeps.org/health/chapters/pdf/Chapter%201%20Introduction.pdf (ultima consultazione 31 maggio 2015).
  47. Kolstad J.T., Chernew M.E. (2009). Quality and consumer decision making in the market for health insurance and health care services. Medical Care Research and Review, 66 (1 suppl): 28S-52S. doi : 10.1177/1077558708325887.
  48. Krugman P., Wells R. (2006). The health care crisis and what to do about it. New York: The New York Review of Books.
  49. Lexchin J., Grootendorst P. (2004). Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: a systematic review of the evidence. International Journal of Health Services, 34 (1): 101-122. DOI: 10.2190/4M3E-L0YF-W1TD-EKG0
  50. Luft H. (1986). Compensating for biased selection in health insurance. Milbank Quarterly, 64 (4):566-591. DOI: 10.2307/3349926
  51. Mladovsky P., Srivastava D., Cylus J., Karanikolos M., Evetovits T., Thomson S., McKee M. (2012). Health policy in the financial crisis. Eurohealth, 18 (1): 3-6.
  52. Mossialos E., Thomson S. (2002). Voluntary health insurance in the European Union: a critical assessment. International Journal of Health Services, 32 (1):19-88. DOI: 10.2190/K6BP-3H1R-L41MHVGE
  53. Mossialos E, Thomson S. (2004). Voluntary health insurance in the European Union. World Health Organization Regional Office for Europe. Copenhagen. Testo disponibile al sito: http://www.euro.who.int/__data/assets/pdf_file/0006/98448/E84885.pdf. (ultima consultazione 24 luglio 2015).
  54. Mossialos E., Permanand G., Beaten R., Hervey T. (2010). Health systems governance in Europe: the role of EU law and policy. Cambridge: Cambridge University Press.
  55. Mushkin S. (1958). Towards a definition of health economics. Public Health Reports, 73 (9): 758-793. DOI: 10.2307/4590242
  56. Nathan R.P. (2013). America’s health care crisis and what to do about it. The Nelson A. Rockfeller Institute of Government, March.
  57. Nuzzo A., Medici F., Pietro Granella P., Galadini M., Carla Ceccolini C., Lentisco S., con la collaborazione di Lispi L. (2012). Rapporto Monitoraggio LEA – Adempimento “mantenimento dell’erogazione dei LEA attraverso gli indicatori della griglia LEA” – Metodologia e Risultati dell’anno 2010, Ministero della Salute. Testo disponibile al sito: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1829_allegato.pdf (ultima consultazione 18 luglio 2015).
  58. Oxley H. , MacFarlan M. (1995). Health Care Reform: Controlling Spending and Increasing Efficiency. Paris: OECD Economics Studies, nr. 24
  59. Office of Fair Trading (1996). Health insurance: a report by the Office of Fair Trading. London: Office of Fair Trading. Testo disponibile al sito: http://webarchive.nationalarchives.go v.uk/20090127101002/http://www.oft.gov.uk/shared_oft/reports/financial_products/oft168. pdf (ultima consultazione 14 luglio 2015).
  60. Office of Fair Trading (1998). Health insurance: a second report by the Office of Fair Trading. London: Office of Fair Trading. Testo disponibile al sito: http://webarchive.nationalarchives.gov. uk/20090127100749/http://www.oft.gov.uk/shared_oft/reports/financial_products/oft230.pdf (ultima consultazione 14 luglio 2015).
  61. Olsen J.O. (2009). Policymaking without policy choice: the rise of private health insurance in Denmark. International Journal of Public Policy, 29(3): 263-285. DOI: 10.1017/S0143814X0999016X.
  62. OECD (2004). Private health insurance in OECD countries. Paris: Organisation for Economic Cooperation and Development.
  63. OECD (2015). OECD Reviews of health care quality: Italy 2014: Raising standards. Paris: OECD Publishing. DOI: 10.1787/22270485
  64. Palm W., Wismar M., van Ginneken E., Busse R., Ernst K., Figueras J. (2011). Toward a renewed Community framework for safe, high-quality and efficient cross-border health care within the European Union. In: Wismar M., Palm W., Figueras J., Ernst K., van Ginneken E. (a cura di). Cross-border health care in the European Union. Copenhagen: European Observatory on Health Systems and Policies. Pammolli F., Salerno N.C. (2008). La Sanità in Italia. Federalismo, regolazione dei mercati, sostenibilità delle finanze pubbliche. Bologna: il Mulino.
  65. Pammolli F., Salerno N.C. (2008). La Sanità in Italia. Federalismo, regolazione dei mercati, sostenibilità delle finanze pubbliche. Bologna: il Mulino.
  66. Piketty T. (2014) Capital in the Twenty-First Century. Cambridge, Massachusetts: Belknap Press of Harvard University Press.
  67. Rapporto PiT Salute (2012). Servizio Sanitario Nazionale e Cittadini: lo Stato (A)sociale. Testo disponibile al sito: http://www.cittadinanzattiva.it/relazioni-annuali/doc_download/129-rapporto-pit-salute-2012-xv.html (ultima consultazione 18 luglio 2015).
  68. Robinson J.C., Casalino L.P. (1996). Vertical integration and organizational networks in health care. Health Affairs, 15 (1): 7-22. doi : 10.1377/hlthaff.15.1.7.
  69. RQuotidiano (2014). Sanità pubblica, ecco l’integrazione con le assicurazioni che piace a Unipol. Il Fatto Quotidiano/Economia & Lobby. Testo disponibile al sito: http://www.ilfattoquotidiano.it/2014/07/09/sanita-pubblica-ecco-lintegrazione-con-le-assicurazioni-che-piace-a-unipol-e-censis/1055109/ (ultima consultazione 24 luglio 2015).
  70. Saliba B., Ventelou B. (2007). Complementary health insurance in France. Who pays? Why? Who will suffer from public disengagement? Health Policy, 81: 166-182. DOI: 10.1016/j.healthpol.2006.05.017
  71. Scharpf F.W. (2002). The European social model: coping with the challenges of diversity. Journal of Common Market Studies, 40 (4): 645-670. DOI: 10.1111/1468-5965.00392.
  72. Semenova A., Kelton S. (2008). Health care reform, universal coverage and financial “basics”. A functional Finance perspective. Center for full employment and price stability. University of Missouri, Kansas City, USA. Testo disponibile al sito: http://www.cfeps.org/health/chapters/pdf/functional%20finance. pdf (ultima consultazione 31 maggio 2015).
  73. Shen C. (2013). Determinants of health care decisions: insurance, utilization, and expenditures. The Review of Economics and Statistics, 95(1): 142-153. DOI: 10.1162/REST_a_00232
  74. Sullivan P. (1992). Taking the pulse of health-care insurance. Journal of Accountancy, 42 (1): 54-58.
  75. Tamblyn R., Laprise R., Hanley J.A., Abrahamowicz M., Scott S., Mayo N., Hurley J., Grad R., Latimer E., Perreault R., McLeod P., Huang A., Larochelle P., Mallet L. (2001). Adverse events associated with prescription drug cost-sharing among poor and elderly persons. Journal of the American Medical Association, 285 (4): 421-429. doi :10.1001/jama.285.4.421.
  76. Thompson R. (1990). 10 ways to cut your health care costs now. Nation’s Business, 78(10): 20. Thomson S., Mossialos E. (2004). What are the equity, efficiency, cost containment and choice implications of private health-care funding in Western Europe? World Health Organization – Regional Office for Europe – HEN, Copenhagen.
  77. Thomson S., Mossialos E. (2009). Private health insurance in the European Union. Final Report prepared for European Commission, Directorate General for Employment, Social Affairs and Equal Opportunities, disponibile al sito: www.ec.europa. eu/social/BlobServlet?docId=4217.
  78. Thomson S., Foubister T., Mossialos E. (2009). Financing health care in the European Union: Challenges and policy responses, disponibile al sito: www.euro.who.int/en/about-us/partners/observatory/publications/studies/old-abstracts/financing-health-care-in-the-european-union-challenges-and-policy-responses.
  79. Thomson S., Mossialos E. (2010). Private health insurance and the internal market. In: Mossialos et al. (a cura di). Health Systems Governance in Europe: the role of EU law and Policy, Cambridge: Cambridge University Press. DOI: 10.1017/CBO9780511750496.011
  80. Thomson S., Figueras J., Evetovits T., Jowett M., Mladovsky P., Maresso A., Cylus J., Karanikolos
  81. M., Kluge H. (2014). Economic crisis, health systems and health in Europe: impact and implications for policy. European observatory on health systems and policies. Copenhagen: WHO-Regional Office for Europe.
  82. Vecchietti M. (2012). Scenari evolutivi per la sanita integrativa. In: RBM Salute – Censis (a cura di). I Fondi Sanitari tra integrazione, sostituzione e complementarietà. Roma: RBM Salute.
  83. Wagstaff A., van Doorslaer E. (1992). Equity in the finance of health care: Some international comparisons. Journal of Health Economics, 11: 361-387. DOI: 10.1016/0167-6296(92)90012-P
  84. Wagstaff A., van Doorslaer E., van der Burg H., Calonge S., Christiansen T., Citoni G., Gerdtham U., Gerfin M., Gross L., Hakinnen U., Johnson P., John J., Klavus J., Lachaud C., Lauritsen J., Leu R., Nolan B., Peran E., Pereira J., Propper C., Puffer F., Rochaix L., Rodriguez M., Schellhorn M., Sundberg G., Winkelhake O. (1999). Equity in the finance of health care: some further international comparisons. Journal of Health Economics, 18 (3): 263-290. DOI: 10.1016/S0167-6296(98)00044-7
  85. O. (1999). Equity in the finance of health care: some further international comparisons. Journal of Health Economics, 18 (3): 263-290. DOI: 10.1016/S0167-6296(98)00044-7
  86. World Health Organization (WHO)(2014). World Health Statistics 2014 – A wealth of information on global public health. Geneva, Switzerland.

Maria Grazia Pirozzi, Sara Saggese, Assicurazioni sanitarie private: conseguenze per i cittadini e implicazioni per il SSN derivanti dalla loro eventuale introduzione. Un’opportunità o un vaso di Pandora? in "MECOSAN" 95/2015, pp 109-136, DOI: 10.3280/MESA2015-095006