Catastrophic Health Expenditure: heterogeneity among Regions and citizenship

We analyze Catastrophic Health Expenditure (CHE) across Italian regions, distinguishing between Italians and foreigners. CHE serves as an indicator of a household’s capacity to manage healthcare costs without financial hardship. Despite free public healthcare, long wait times frequently drive individuals to opt for private services, thereby increasing the risk of CHE. Our findings, based on a Beta zero-inflated SAE-GAMLSS model, reveal substantial disparities between Italians and foreigners, underscoring a paradox in Italy’s universally accessible healthcare system.