An Index of Household Accessibility to Basic Services: A Study of Italian Regions

Article

Abstract

The level of accessibility to basic services is an important issue because it is closely related to social inclusion and social capital, key aspects of societal well-being. There is a large and growing literature on access to health care in an era of dwindling public resources due to recent economic downturns. Health care is an essential service, but it is not the only basic service. The literature on access to basic services including, but not limited to, health care is relatively small. The paper aims at contributing to the literature by providing a new index to measure and monitor household accessibility to basic services. A study of Italian regions is presented. It is shown that northern regions have more accessible basic services than central, southern and island regions. A longitudinal comparison has been performed. The results are very worrying because show that policy makers have failed in reducing regional (and in particular north–south) disparities in basic service accessibility. Measuring and monitoring the level of accessibility is central for an adequate provision of basic services and for exploring how the delivery of basic services in the most problematic regions can be improved.

Keywords

Composite indicator Social capital Social inclusion Uncertainty analysis Monte Carlo methods 

References

  1. Andersen, R. M., Yu, H., Wyn, R., Davidson, P. L., Brown, E. R., & Teleki, S. (2002). Access to medical care for low-income persons: How do communities make a difference? Medical Care Research and Review, 59, 384–411.CrossRefGoogle Scholar
  2. Atkinson, A. B., Marlier, E., & Nolan, B. (2004). Indicators and targets for social inclusion in the European Union. Journal of Common Market Studies, 42, 47–75.CrossRefGoogle Scholar
  3. Balarajan, Y., Selvaraj, S., & Subramanian, S. (2011). Health care and equity in India. The Lancet, 377, 505–515.CrossRefGoogle Scholar
  4. Boccuzzo, G., & Gianecchini, M. (2014). Measuring young graduates job quality through a composite indicator. Social Indicators Research. doi: 10.1007/s11205-014-0695-6.
  5. Burr, J. A., Mutchler, J. E., & Warren, J. P. (2005). State commitment to home and community-based services: Effects on independent living for older unmarried women. Journal of Aging & Social Policy, 17, 1–18.CrossRefGoogle Scholar
  6. Choi, S. (2015). How does satisfaction with medical care differ by citizenship and nativity status?: A county-level multilevel analysis. The Gerontologist, 55, 735–747.CrossRefGoogle Scholar
  7. Dasgupta, P. (2000) Valutation and evaluation: Measuring the quality of life and evaluating policy. LSE STICERD, 22. Available at SSRN: http://ssrn.com/abstract=1126991. Accessed February 15, 2016.
  8. Demaerschalk, M. F., Vanden Boer, L. E., Bronselaer, J. L., Molenberghs, G., & Declercq, A. G. (2013). The influence of municipal characteristics on the use of informal home care and home care services by the elderly Flemish. The European Journal of Public Health, 23, 241–246.CrossRefGoogle Scholar
  9. Dickes, P., & Valentova, M. (2013). Construction, validation and application of the measurement of social cohesion in 47 European countries and regions. Social Indicators Research, 113, 827–846.CrossRefGoogle Scholar
  10. Elkin, E. B., Ishill, N. M., Snow, J. G., Panageas, K. S., Bach, P. B., Liberman, L., et al. (2010). Geographic access and the use of screening mammography. Medical Care, 48, 349–356.CrossRefGoogle Scholar
  11. European Union. (2016). European Regional Development Fund. http://ec.europa.eu/regional_policy/en/funding/erdf. Accessed February 15, 2016.
  12. European Union. (2016). Cohesion Fund. http://ec.europa.eu/regional_policy/en/funding/cohesion--fund. Accessed February 15, 2016.
  13. European Union. (2016). Beyond GDP: Measuring progress, true wealth, and the well–being of nations. http://ec.europa.eu/environment/beyond_gdp/index_en.html. Accessed February 15, 2016.
  14. Fayers, P. M., & Hand, D. J. (2002). Causal variables, composite indicators and measurement scales: An example from quality of life. Journal of the Royal Statistical Society Series A, 165, 233–261.CrossRefGoogle Scholar
  15. Hagerty, M. R., & Land, K. C. (2007). Constructing summary indices of quality of life. Sociological Methods & Research, 35, 455–496.CrossRefGoogle Scholar
  16. Harris, B., Goudge, J., Ataguba, J. E., McIntyre, D., Nxumalo, N., Jikwana, S., et al. (2011). Inequities in access to health care in South Africa. Journal of Public Health Policy, 32, S102–S123.CrossRefGoogle Scholar
  17. Hendryx, M. S., Ahern, M. M., Lovrich, N. P., & McCurdy, A. H. (2002). Access to health care and community social capital. Health Services Research, 37, 85–101.CrossRefGoogle Scholar
  18. Hoskins, B., Saisana, M., & Villalba, C. M. H. (2014). Civic competence of youth in Europe: Measuring cross national variation through the creation of a composite indicator. Social Indicators Research. doi: 10.1007/s11205-014-0746-z.
  19. Italian Ministry of Health. (2016). LEA (Livelli essenziali di assistenza: basic level of medical assistance). www.salute.gov.it/portale/temi/p2_5.jsp?area=programmazioneSanitariaLea&menu=lea. Accessed February 15, 2016.
  20. Italian National Institute of Statistics. (2015). Aspetti della vita quotidiana. www.istat.it/it/archivio/129916. Accessed February 15, 2016.
  21. Italian National Institute of Statistics. (2016). BES (Benessere Equo e Sostenibile: Equitable and sustainable well-being). http://www.istat.it/en/files/2015/03/bes. Accessed February 15, 2016.
  22. Janes, C. R., Chuluundorj, O., Hilliard, C. E., Rak, K., & Janchiv, K. (2006). Poor medicine for poor people? Assessing the impact of neoliberal reform on health care equity in a post-socialist context. Global Public Health, 1, 5–30.CrossRefGoogle Scholar
  23. Kentikelenis, A., Karanikolos, A., Papanicolas, A., Basu, S., McKee, M., & David Stuckler, B. (2011). Health effects of financial crisis: Omens of a Greek tragedy. The Lancet, 378, 1457–1458.CrossRefGoogle Scholar
  24. Kirby, J. B., & Kaneda, T. (2005). Neighborhood socioeconomic disadvantage and access to health care. Journal of Health and Social Behavior, 46, 15–31.CrossRefGoogle Scholar
  25. Kirby, J. B., & Kaneda, T. (2006). Access to health care: Does neighborhood residential instability matter? Journal of Health and Social Behavior, 47, 142–155.CrossRefGoogle Scholar
  26. Lago, A., & Pesarin, F. (2000). Nonparametric combination of dependent rankings with application to the quality assessment of industrial products. Metron, 58, 39–52.Google Scholar
  27. Lasser, K. E., Himmelstein, D. U., & Woolhandler, S. (2006). Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey. American Journal of Public Health, 96, 1300–1307.CrossRefGoogle Scholar
  28. Lehnert, T., Leicht, H., Heinrich, S., Corrieri, S., Luppa, M., Riedel-Heller, S., et al. (2011). Review: Health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68, 47–75.CrossRefGoogle Scholar
  29. Marozzi, M. (2009). A composite indicator dimension reduction procedure with application to university student satisfaction. Statistica Neerlandica, 63, 258–268.CrossRefGoogle Scholar
  30. Marozzi, M. (2012). Tertiary student satisfaction with socialization: A statistical assessment. Quality and Quantity, 46, 1271–1278.CrossRefGoogle Scholar
  31. Marozzi, M. (2014). Construction, dimension reduction and uncertainty analysis of an index of trust in public institutions. Quality and Quantity, 48, 939–953.CrossRefGoogle Scholar
  32. Marozzi, M. (2015). Measuring trust in European public institutions. Social Indicators Research, 123, 879–895.CrossRefGoogle Scholar
  33. Marozzi, M. (2016). Construction, robustness assessment and application of an index of perceived level of socio-economic threat from immigrants: A study of 47 European countries and regions. Social Indicators Research, 128, 413–437.CrossRefGoogle Scholar
  34. Marozzi, M., & Bolzan, M. (2016). Skills and training requirements of municipal directors: a statistical assessment. Quality and Quantity, 50, 1093–1115.CrossRefGoogle Scholar
  35. Masseria, C., & Giannoni, M. (2010). Equity in access to health care in Italy: A disease-based approach. The European Journal of Public Health, 20, 504–510.CrossRefGoogle Scholar
  36. McLafferty, S. L. (2003). GIS and health care. Annual Review of Public Health, 24, 25–42.CrossRefGoogle Scholar
  37. Mechanic, D. (2002). Disadvantage, inequality, and social policy. Health Affairs, 21, 48–59.CrossRefGoogle Scholar
  38. Meng, Q., Xu, L., Zhang, Y., Qian, J., Cai, M., Xin, Y., et al. (2012). Trends in access to health services and financial protection in China between 2003 and 2011: A cross-sectional study. Lancet, 379, 805–814.CrossRefGoogle Scholar
  39. OECD (2008) Handbook on constructing composite indicators. www.oecd.org/std/42495745. Accessed February 25, 2016.
  40. OECD. (2015). Health at a glance 2015. OECD Indicators. www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm. Accessed February 14, 2016.
  41. Pitkin Derose, K., & Varda, D. M. (2009). Social capital and health care access. A systematic review. Medical Care Research and Review, 66, 272–306.CrossRefGoogle Scholar
  42. Reading, R., & Reynolds, S. (2001). Debt, social disadvantage and maternal depression. Social Science & Medicine, 53, 441–453.CrossRefGoogle Scholar
  43. Remington, P. L., & Booske, B. C. (2011). Measuring the health of communities—How and why? Journal of Public Health Management & Practice, 17, 397–400.CrossRefGoogle Scholar
  44. Rosero-Bixby, L. (2004). Spatial access to health care in Costa Rica and its equity: A GIS-based study. Social Science & Medicine, 58, 1271–1284.CrossRefGoogle Scholar
  45. Saisana, M., Saltelli, A., & Tarantola, S. (2005). Uncertainty and sensitivity analysis techniques as tools for the quality assessment of composite indicators. Journal of the Royal Statistical Society Series A, 168, 307–323.CrossRefGoogle Scholar
  46. Saisana, M., d’Hombres, B., & Saltelli, A. (2011). Rickety numbers: Volatility of university rankings and policy implications. Research Policy, 40, 165–177.CrossRefGoogle Scholar
  47. Scheppers, E., van Dongen, E., Dekker, J., Geertzen, J., & Dekker, J. (2006). Potential barriers to the use of health services among ethnic minorities: A review. Family Practice, 23, 248–325.CrossRefGoogle Scholar
  48. Snowden, L. R., & McClellan, S. R. (2013). Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients. American Journal of Public Health, 103, 1628–1633.CrossRefGoogle Scholar
  49. Trani, J. F., & Barbou-des-Courieres, C. (2012). Measuring equity in disability and healthcare utilization in Afghanistan. Medicine, Conflict and Survival, 28, 219–246.CrossRefGoogle Scholar
  50. Van Doorslaer, E., Masseria, C., & Koolman, X. (2006). Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal, 174, 177–183.CrossRefGoogle Scholar
  51. Waites, C. (2013). Examining the perceptions, preferences, and practices that influence healthy aging for African American older adults. Journal of Applied Gerontology, 32, 855–875.CrossRefGoogle Scholar
  52. Wight, R. G., Cummings, J. R., Karlamangla, A. S., & Aneshensel, C. S. (2010). Urban neighborhood context and mortality in late life. Journal of Aging and Health, 22, 197–218.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Department of Environmental Sciences, Informatics and StatisticsCa’ Foscari University of VeniceVenezia MestreItaly
  2. 2.Department of Statistical SciencesUniversity of PaduaPadovaItaly

Personalised recommendations