Spatial Heterogeneities or Inequalities? Health Care Supply and Demand of the Older Population in Italy

Abstract There are significant disparities in health care resources across different regions of Italy, particularly between the centre-north and the south. Public health care spending is notably lower in southern Italy. As a result, health related migration is a major phenomenon, with many individuals traveling to other regions - especially from the south to the centre-north - to receive better medical care, particularly for serious illnesses. During the COVID-19 pandemic, health migration declined significantly, underscoring the crucial role of local and regional health care systems in responding to external shocks. This study examines health care accessibility for older people at municipality level in three regions: Lombardy (northern Italy), Tuscany (central Italy), and Molise (southern Italy). It assesses inequalities in health care supply and demand and evaluates regional health care system responses using the Enhanced Two-Step Floating Catchment Area (E2SFCA) method. Health care accessibility varies considerably across these regions. While Lombardy and Tuscany generally offer high accessibility, Molise faces significant challenges. A substantial proportion of older residents in rural areas of Molise have no access to health care facilities within a 30-minute travel time. This disparity may contribute to inequalities in local health care access, potentially leading to severe consequences for the health and well-being of the older population.