Italian regional variation in amenable mortality 2015/2019: impact of outsourcing, expenditures and socio-economic variables

Background: This study addresses the need to monitor regional performance in decentralized health systems and determine the main variables associated with regional variability. Amenable mortality serves as a pivotal performance indicator of healthcare systems. Methods: An observational study was grounded from 2015 to 2019. The regional variability in amenable mortality, using age-standardized death rates (SDRs), was analyzed. Variation among regions was examined against other variables; Socio-economic (net household income, poverty rates, education level, and ethnic minority rates), Healthcare expenditure variables (per capita public and private health expenditure, inpatient and outpatient services outsourcing toward for-profit providers). A multivariate regression model was utilized, including all variables to examine the overall associations with amenable mortality. Results: The results showed that from 2015 to 2019 the SDRs range widely among regions. We found in the multivariate regression model that an annual increase of one percentage point of outsourcing to the private sector, poverty rate, ethnic minority rate were associated with an annual increase in amenable mortality; by contrast, an annual increase of one percentage point of household net income was associated with a slight annual decrease in amenable mortality. Conclusion: The study highlights that in decentralized systems, performance, measuring in amenable mortality, can be different. Some variables can explain and affect this variability. Policy makers should make an integrated reading of these findings to undertake measures capable of improving regional amenable mortality and should monitor healthcare system metrics, especially in the face of evolving practices such as outsourcing.