Occupation and demand for health services in Italy: Ways and means to reduce the opportunity costs imposed on patients

This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian National Institute of Statistics (ISTAT), we estimate a negative binomial regression model of GP visits as a function of employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We conclude that they have higher opportunity costs than white and blue collars since they suffer more from the loss of earnings related to the absence from work. Self-employed individuals often face barriers to accessing healthcare services, such as lack of employer-sponsored health insurance and concerns about lost income during time off for medical appointments. As a result, they may delay seeking healthcare until their condition becomes more severe, leading to poorer health outcomes. Managers and cadres, on the other hand, may have greater access to healthcare services due to higher income levels and better job benefits. However, they may still face challenges such as long working hours and job-related stress, which can impact their ability to prioritize their health and seek timely medical care. From a policy perspective, our results suggest potential policy interventions aimed at addressing barriers to healthcare access for self-employed workers and promoting equitable healthcare utilization across different employment groups. Policy recommendations may include measures to enhance financial support (tax deductions for medical expenses, subsidies for health insurance premiums, or grants to cover the costs of healthcare-related absences from work), increase healthcare accessibility (enhancing the availability of mobile clinics, and extending operating hours for primary care facilities to accommodate the needs of working individuals) and raise awareness about preventive care among self-employed workers (workplace wellness programs, and incentives for regular health check-ups, screenings and healthy lifestyle choices, can encourage managers and self-employed workers to prioritize preventive measures). These policy implications are essential for ensuring equitable and universal access to healthcare services for all workers, regardless of their employment status.