Health-care demand and supply at municipal level: A spatial disaggregation approach

Improving the performance of the health care system has become a key policy issue to reduce the tensions between increasing demands and limited resources. In this paper, we address an innovative methodology and application framework for measuring health sector performance at a highly disaggregated level, offering a perspective that has been pursued to a limited extent. Using a decentralised country such as Italy as a case study and micro-territorial information, a composite indicator of health demand at the provincial level is first proposed. Then, using a spatially disaggregated method derived from the well-established Chow-Lin techniques, a municipality-level indicator is estimated to identify health needs and territorial imbalances between local supply and demand. It is found that there are specific spatial patterns in both demand and supply that should be taken into account to avoid inequitable supply tied to a regional boundary, and that health risk increases with spatial distance to health facilities. These findings highlight the lower responsiveness of peripheral areas and the ability to maintain an effective network across the territory, due to the simultaneous dismantling and fragmentation of territorial primary health care over the last 20 years in Italy.