{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:00:35Z","timestamp":1790694035078,"version":"4.1.0"},"reference-count":61,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004271","name":"University of Rome La Sapienza","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004271","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004434","name":"University of Florence","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Economics & Human Biology"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.ehb.2026.101635","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T06:06:26Z","timestamp":1785996386000},"page":"101635","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Private healthcare expenditure and unmet medical needs: Assessing regional disparities in Italy"],"prefix":"10.1016","volume":"62","author":[{"given":"Clara","family":"Andresciani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Di Gioacchino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sabani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ehb.2026.101635_b1","series-title":"La mobilit\u00e0 sanitaria in Italia. Edizione 2023","author":"Agenas","year":"2023"},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s13643-024-02647-5","article-title":"Social determinants of unmet need for primary care: a systematic review","volume":"13","author":"Alemu","year":"2024","journal-title":"Syst. Rev."},{"issue":"3","key":"10.1016\/j.ehb.2026.101635_b3","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.socscimed.2009.10.027","article-title":"Subjective unmet need and utilization of health care services in Canada: what are the equity implications?","volume":"70","author":"Allin","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.ehb.2026.101635_b4","series-title":"Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects","article-title":"Measuring equity of access to health care","author":"Allin","year":"2009"},{"key":"10.1016\/j.ehb.2026.101635_b5","article-title":"Unmet need as an indicator of health care access","author":"Allin","year":"2009","journal-title":"Eurohealth"},{"key":"10.1016\/j.ehb.2026.101635_b6","series-title":"Public\/private mix in healthcare: Assessing the decongestion effect argument","author":"Andresciani","year":"2025"},{"key":"10.1016\/j.ehb.2026.101635_b7","series-title":"Stiamo Privatizzando la Sanit\u00e0?","author":"Aracano","year":"2024"},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b8","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.econmod.2009.11.001","article-title":"The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: a population-based investigation","volume":"27","author":"Berta","year":"2010","journal-title":"Econ. Model."},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b9","first-page":"979","article-title":"Public provision of private goods and the redistribution of income","volume":"81","author":"Besley","year":"1991","journal-title":"Am. Econ. Rev."},{"issue":"2","key":"10.1016\/j.ehb.2026.101635_b10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0047-2727(98)00108-X","article-title":"The demand for private health insurance: do waiting lists matter?","volume":"72","author":"Besley","year":"1999","journal-title":"J. Public Econ."},{"issue":"7","key":"10.1016\/j.ehb.2026.101635_b11","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.healthpol.2016.05.002","article-title":"Public\u2013private sector interactions and the demand for supplementary health insurance in the United Kingdom","volume":"120","author":"B\u00edr\u00f3","year":"2016","journal-title":"Health Policy"},{"issue":"2\u20133","key":"10.1016\/j.ehb.2026.101635_b12","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.healthpol.2011.10.003","article-title":"Quasi-market and cost-containment in Beveridge systems: the Lombardy model of Italy","volume":"103","author":"Brenna","year":"2011","journal-title":"Health Policy"},{"issue":"2","key":"10.1016\/j.ehb.2026.101635_b13","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s40258-017-0365-3","article-title":"Rich and well educated: are these requirements necessary to claim healthcare tax credits in Italy?","volume":"16","author":"Brenna","year":"2018","journal-title":"Appl. Health Econ. Health Policy"},{"key":"10.1016\/j.ehb.2026.101635_b14","doi-asserted-by":"crossref","DOI":"10.1016\/j.healthpol.2025.105271","article-title":"Public versus private access in the Italian NHS-The use of Propensity Score Matching to provide more insight on the increasing adoption of voluntary health insurance","author":"Brenna","year":"2025","journal-title":"Health Policy"},{"key":"10.1016\/j.ehb.2026.101635_b15","series-title":"Regional Disparities in Access to Health Care: a Multilevel Analysis in Selected OECD Countries","author":"Brezzi","year":"2016"},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-017-2667-4","article-title":"Effect of having private health insurance on the use of health care services: the case of Spain","volume":"17","author":"Cantarero-Prieto","year":"2017","journal-title":"BMC Health Serv. Res."},{"key":"10.1016\/j.ehb.2026.101635_b17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-072X-12-27","article-title":"Geographical variation of unmet medical needs in Italy: a multivariate logistic regression analysis","volume":"12","author":"Cavalieri","year":"2013","journal-title":"Int. J. Health Geogr."},{"issue":"1\u20132024","key":"10.1016\/j.ehb.2026.101635_b18","first-page":"203","article-title":"Spesa sanitaria privata e assicurazioni integrative: alcune evidenze dall\u2019indagine SHARE","volume":"103","author":"Celidoni","year":"2024","journal-title":"Riv. Politica Econ."},{"issue":"7","key":"10.1016\/j.ehb.2026.101635_b19","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s10198-014-0629-x","article-title":"Health system characteristics and unmet care needs in Europe: an analysis based on EU-SILC data","volume":"16","author":"Chaupain-Guillot","year":"2015","journal-title":"Eur. J. Health Econ."},{"key":"10.1016\/j.ehb.2026.101635_b20","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jhealeco.2013.11.007","article-title":"Measuring the effects of reducing subsidies for private insurance on public expenditure for health care","volume":"33","author":"Cheng","year":"2014","journal-title":"J. Health Econ."},{"key":"10.1016\/j.ehb.2026.101635_b21","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1111\/1475-6773.13555","article-title":"Unmet social needs among low-income adults in the United States: Associations with health care access and quality","volume":"55","author":"Cole","year":"2020","journal-title":"Health Serv. Res."},{"key":"10.1016\/j.ehb.2026.101635_b22","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1111\/j.1468-0440.2004.00312.x","article-title":"Preference for National Health Service use and the demand for private health insurance in Spain","volume":"29","author":"Costa-Font","year":"2004","journal-title":"Geneva Pap. Risk Insur.-Issues Pract."},{"issue":"9","key":"10.1016\/j.ehb.2026.101635_b23","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1002\/hec.823","article-title":"Fixed fees and physician-induced demand: A panel data study on French physicians","volume":"12","author":"Delattre","year":"2003","journal-title":"Health Econ."},{"key":"10.1016\/j.ehb.2026.101635_b24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s10198-017-0884-8","article-title":"Do healthcare tax credits help poor-health individuals on low incomes?","volume":"19","author":"Di Novi","year":"2018","journal-title":"Eur. J. Health Econ."},{"issue":"305","key":"10.1016\/j.ehb.2026.101635_b25","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/1475-4932.12394","article-title":"The effect of health insurance on the substitution between public and private hospital care","volume":"94","author":"Doiron","year":"2018","journal-title":"Econ. Rec."},{"key":"10.1016\/j.ehb.2026.101635_b26","article-title":"Which direction should Australian health system reform be heading?","author":"Eckermann","year":"2015","journal-title":"Aust. N. Z. J. Public Health"},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b27","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/obes.12107","article-title":"Opt out or top up? Voluntary health care insurance and the public vs. private substitution","volume":"78","author":"Fabbri","year":"2016","journal-title":"Oxf. Bull. Econ. Stat."},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b28","article-title":"Il welfare aziendale e la salute","author":"Ferroni","year":"2024","journal-title":"Riv. Politica Econ."},{"key":"10.1016\/j.ehb.2026.101635_b29","series-title":"Assessing Health System Performance: Proof of Concept for a HSPA Dashboard of Key Indicators [Internet]","article-title":"Assessing access and quality","author":"Figueras","year":"2023"},{"issue":"417","key":"10.1016\/j.ehb.2026.101635_b30","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/01621459.1992.10475190","article-title":"Generalized collinearity diagnostics","volume":"87","author":"Fox","year":"1992","journal-title":"J. Amer. Statist. Assoc."},{"issue":"S1","key":"10.1016\/j.ehb.2026.101635_b31","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1002\/hec.1035","article-title":"The Italian health-care system","volume":"14","author":"France","year":"2005","journal-title":"Health Econ."},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b32","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/1471-2458-10-296","article-title":"Determinants of health disparities between Italian regions","volume":"10","author":"Franzini","year":"2010","journal-title":"BMC Public Health"},{"key":"10.1016\/j.ehb.2026.101635_b33","series-title":"The Supply of Surgeons and the Demand for Operations","author":"Fuchs","year":"1978"},{"key":"10.1016\/j.ehb.2026.101635_b34","series-title":"I Fondi Sanitari Integrativi in Italia \u2013 3o Rapporto 2021\u20132023","author":"Giannetti","year":"2024"},{"issue":"9","key":"10.1016\/j.ehb.2026.101635_b35","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/S0277-9536(00)00415-9","article-title":"Equity of access to health care services: Theory and evidence from the UK","volume":"53","author":"Goddard","year":"2001","journal-title":"Soc. Sci. Med."},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b36","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s11019-025-10287-2","article-title":"Addressing the overuse-underuse paradox in healthcare","volume":"28","author":"Hofmann","year":"2025","journal-title":"Med. Health Care Philos."},{"issue":"Suppl 1","key":"10.1016\/j.ehb.2026.101635_b37","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1093\/geroni\/igaa057.1220","article-title":"Social determinants of unmet healthcare needs: comparison between middle-aged and older people","volume":"4","author":"Hong","year":"2020","journal-title":"Innov. Aging"},{"issue":"2","key":"10.1016\/j.ehb.2026.101635_b38","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/0047-2727(90)90030-L","article-title":"The mix of social and private provision of goods and services","volume":"43","author":"Ireland","year":"1990","journal-title":"J. Public Econ."},{"key":"10.1016\/j.ehb.2026.101635_b39","series-title":"Monitoraggio della Spesa Sanitaria 2024 \u2013 Rapporto n.11","author":"Italian Ministry of Finance","year":"2024"},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b40","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/S0167-6296(96)00518-8","article-title":"The effect of a private sector on the waiting time in a national health service","volume":"16","author":"Iversen","year":"1997","journal-title":"J. Health Econ."},{"key":"10.1016\/j.ehb.2026.101635_b41","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1023\/A:1019024903898","article-title":"Public health care and private insurance demand: the waiting time as a link","volume":"3","author":"Jofre-Bonet","year":"2000","journal-title":"Health Care Manag. Sci."},{"key":"10.1016\/j.ehb.2026.101635_b42","series-title":"Monitoraggio dei LEA Attraverso il Nuovo Sistema di Garanzia \u2013 Relazione 2022","author":"Lispi","year":"2024"},{"issue":"6","key":"10.1016\/j.ehb.2026.101635_b43","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.healthpol.2021.03.007","article-title":"Incentives for voluntary health insurance in a national health system: Evidence from Italy","volume":"125","author":"Marenzi","year":"2021","journal-title":"Health Policy"},{"key":"10.1016\/j.ehb.2026.101635_b44","series-title":"Status Syndrome: How your Social Standing Directly Affects your Health","author":"Marmot","year":"2005"},{"issue":"5","key":"10.1016\/j.ehb.2026.101635_b45","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1093\/eurpub\/ckq029","article-title":"Equity in access to health care in Italy: a disease-based approach","volume":"20","author":"Masseria","year":"2010","journal-title":"Eur. J. Pub. Health"},{"key":"10.1016\/j.ehb.2026.101635_b46","series-title":"Annuario statistico del servizio sanitario nazionale. Anno 2023","author":"Ministero della Salute","year":"2023"},{"key":"10.1016\/j.ehb.2026.101635_b47","series-title":"Private Health Care Consumption in Italy. The Sector at a Glance","author":"OCPS","year":"2018"},{"key":"10.1016\/j.ehb.2026.101635_b48","series-title":"Health at a Glance: Europe 2018: State of Health in the EU Cycle","author":"OECD","year":"2018"},{"key":"10.1016\/j.ehb.2026.101635_b49","series-title":"Un\u2019analisi sulle disparit\u00e0 del meccanismo delle detrazioni per spese sanitarie","author":"Ongaro","year":"2018"},{"issue":"1","key":"10.1016\/j.ehb.2026.101635_b50","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1186\/s12889-019-7502-x","article-title":"The geography and economics of forgoing medical examinations or therapeutic treatments in Italy during the economic crisis","volume":"19","author":"Petrelli","year":"2019","journal-title":"BMC Public Health"},{"issue":"6","key":"10.1016\/j.ehb.2026.101635_b51","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S0167-6296(00)00045-X","article-title":"The demand for private health care in the UK","volume":"19","author":"Propper","year":"2000","journal-title":"J. Health Econ."},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b52","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1017\/S0047279401006444","article-title":"A larger role for the private sector in financing UK health care: the arguments and the evidence","volume":"30","author":"Propper","year":"2001","journal-title":"J. Soc. Policy"},{"issue":"2","key":"10.1016\/j.ehb.2026.101635_b53","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1086\/653137","article-title":"Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance","volume":"118","author":"Propper","year":"2010","journal-title":"J. Political Econ."},{"key":"10.1016\/j.ehb.2026.101635_b54","doi-asserted-by":"crossref","DOI":"10.1016\/j.econmod.2023.106190","article-title":"Voluntary health insurance and out-of-pocket payments in European OECD countries","volume":"120","author":"Purcel","year":"2023","journal-title":"Econ. Model."},{"key":"10.1016\/j.ehb.2026.101635_b55","first-page":"36","article-title":"Bed supply and hospital utilization: a natural experiment","volume":"35","author":"Roemer","year":"1961","journal-title":"Hospitals"},{"issue":"1\u20132","key":"10.1016\/j.ehb.2026.101635_b56","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.healthpol.2013.06.002","article-title":"To what extent does employer-paid health insurance reduce the use of public hospitals?","volume":"113","author":"S\u00f8gaard","year":"2013","journal-title":"Health Policy"},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b57","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0047-2727(74)90005-X","article-title":"The demand for education in public and private school systems","volume":"3","author":"Stiglitz","year":"1974","journal-title":"J. Public Econ."},{"issue":"2","key":"10.1016\/j.ehb.2026.101635_b58","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.healthpol.2009.09.013","article-title":"Are English treatment centres treating less complex patients?","volume":"94","author":"Street","year":"2010","journal-title":"Health Policy"},{"issue":"242","key":"10.1016\/j.ehb.2026.101635_b59","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/1475-4932.00057","article-title":"Will subsidising private health insurance help the public health system?","volume":"78","author":"Vaithianathan","year":"2002","journal-title":"Econ. Rec."},{"issue":"6","key":"10.1016\/j.ehb.2026.101635_b60","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1002\/hec.4811","article-title":"Effects of private health insurance on waiting time in public hospitals","volume":"33","author":"Yang","year":"2024","journal-title":"Health Econ."},{"issue":"4","key":"10.1016\/j.ehb.2026.101635_b61","doi-asserted-by":"crossref","first-page":"mzad096","DOI":"10.1093\/intqhc\/mzad096","article-title":"Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis","volume":"35","author":"Zheng","year":"2023","journal-title":"Int. J. Qual. Health Care"}],"container-title":["Economics & Human Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1570677X26000651?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1570677X26000651?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:34:53Z","timestamp":1790692493000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1570677X26000651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":61,"alternative-id":["S1570677X26000651"],"URL":"https:\/\/doi.org\/10.1016\/j.ehb.2026.101635","relation":{},"ISSN":["1570-677X"],"issn-type":[{"value":"1570-677X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Private healthcare expenditure and unmet medical needs: Assessing regional disparities in Italy","name":"articletitle","label":"Article Title"},{"value":"Economics & Human Biology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ehb.2026.101635","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"101635"}}