نبذة مختصرة : Equity has long been considered an important goal in the health sector. Yet, inequalities between different social groups persist. In particular, lower-status socioeconomic groups tend to suffer higher rates of mortality and morbidity than do higher-status socioeconomic groups. Also, disadvantaged groups often use health care services less, despite generally having higher levels of need. Scholars often argue that these inequalities reflect mainly differences in constraints, rather than differences in preferences, so that they should be considered as inequities, i.e., as an instance of social injustice. The purpose of this dissertation is to investigate whether, and to what extent, patterns of access to health care services deviate from the ideal of horizontal equity – i.e., equal access for equal need – in a country with a universal and egalitarian health care system: Italy. The Italian National Health Service (Servizio Sanitario Nazionale – Ssn) was established in 1978 through a major reform largely inspired by the British Nhs, with the declared goal of providing uniform and comprehensive care to all Italian citizens. The reform rested on the egalitarian principle that health care should be financed according to ability to pay – through general taxation – but distributed according to need, thereby setting out equity objectives in terms of both financial contribution and access to care. There is evidence, however, that these goals have not been fully achieved yet. The present work aims at analyzing this issue and bridging some of the method- ological and substantive gaps in existing research. Using large-scale survey data collected in three different years (1994, 2000, and 2005) and multilevel regression modeling, we investigate whether and how the probability of accessing a compre- hensive set of health care services varies among individuals with equal need but different socioeconomic status (Ses). Along with the standard indicators of health care utilization (GP visits, specialist visits, and inpatient ...
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