FAIRNESS OF NATIONAL HEALTH SERVICE IN ITALY: A BIVARIATE CORRELATED RANDOM EFFECTS MODEL

Abstract

In this paper we consider a possible way of measuring equity in health as the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage. Starting from the fairness approach developed by the World Health Organization, we propose to extend the analysis of fairness in nancing contribution through a generalized linear mixed models framework by introducing a bivariate correlated random effects model. We aim at analyzing the burden of health care payment on Italian households by modeling catastrophic payments and impoverishment due to health care expenditures. For this purpose, we describe a bivariate model for binary data, where association between the outcomes is modeled through outcome-specic latent effects which are assumed to be correlated; we show how model parameters can be estimated in a nite mixture context. By using such model specication, the fairness of the Italian national health service is investigated.fairness, health care, random eects models, binary data, non parametric maximum likelihood.