Universality, Equality and Equity in The Italian National Health Service: Highlighting Discrimination Phenomena in Accessing Health Services Using Institutional and Administrative Data

The Italian NHS must guarantee to all citizens, in conditions of equality, universal access to the equitable provision of health services. In the current institutional framework of healthcare federalism, the central government has the responsibility to ensure these rights through a strong system of guarantees summarized in the Essential Levels of Care (LEAs), and at the same time the Regional Authorities have direct responsibility through their Local Health Authorities (AUSLs) for the implementation of government and expenditure for achieving the country’s health objectives. The monitoring of the LEA by the Ministry of Health (data available since 2001) it would be the tool for verification of the maintenance of the NHS principles, avoiding discrimination in accessing health services. It is an ex post instrument with indicators that do not specifically address each policy of reorganization of services or spending containment. But it is the only complete tool available to everyone and it is possible to read the regional indicators, highlighting the phenomena of non-access to NHS services, the groups that are affected, and the changes over time. More in depth concerning the progressive changes in the offer of services for the early detection of breast cancer in the area of Bologna AUSL (poster at AEA Meeting 2017: Gatti, 2017)), the data (2002-2016) from the Regional Health Service of Emilia-Romagna on the access to the mammographic services in the AUSLs of the region allow to present the results of a longitudinal analysis on the different paths for the early detection of breast cancer undertaken by the women in Bologna and in the other AUSLs in Emilia-Romagna after the solutions adopted after 2010 to deal with the problems of waiting lists and the control of spending for the services of early detection of breast cancer, redirecting the services toward the screening of public health. I present two ways to achieve information on discrimination in accessing health services in the Italian NHS: a) analyzing the data of the monitoring of the Essential Levels of Care, b) reconstructing the access choices from the administrative data of the regional health services.