Riassunto analitico
The intramoenia policy in Italy is a measure that regulates the dual practice of doctors within the National Health Service (NHS). The impact of intramoenia on healthcare access is complex due to limited data and research. It may improve accessibility and reduce waiting times, but could also lower the quality and equity of services, creating a two-tiered healthcare system and increasing socio-economic inequalities. Further research and analysis are needed to fully understand its implications. In response to a lack of economic literature in this particular field, we started a research project, supported by Fondazione Mario Del Monte and Fondazione Ermanno Gorrieri, to understand the phenomenon of intramoenia in the Modena area within the context of Emilia-Romagna and nationally. We shed light on time trends and on the use of intramoenia by conducting three separate empirical investigations - at the macro-level, meso-level, and micro-level - using administrative data sources. For the analyses at macro and meso-level, we used the most up-to-date publicly available data collated from different sources. For the micro-level analysis, we used highly sensitive data provided by a single hospital (Sassuolo Hospital). As we progressed, we encountered increasingly complex datasets, with a noticeable shift from highly aggregated data to individual-level (doctors and patients) data. At the national level, we observed that in Italy, intramoenia appears to be more prevalent in regions with better healthcare performance, challenging the assumption that dual practice is inherently and unequivocally harmful to the public sector. At the regional level, we found a significant increase in the demand for intramoenia services in the Modena area, positioning it at the forefront in Emilia-Romagna. The data we obtained from Sassuolo Hospital at the local level has provided us with valuable insights into the characteristics of both the intramoenia providers and consumers. One intriguing implication we uncovered is that long waiting lists are not necessarily associated with this aspect.
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