Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services.

The paper investigated differences in the use of hospital care, out-patient care and pharmaceutical care in Piemonte, a region of northern Italy with 4,000,000 inhabitants, taking into account factors of need and supply, for capitation purposes. The study used a geographical design, with the municipalities as statistical units, and was based on integrated data from health and health service information systems, the population census and on the geographical distances among municipalities. Hierarchical regression models were fitted with the utilisation of services as the outcome variable and a set of direct and indirect factors of need and supply indicators as covariates. Higher health service consumption rates were observed for the most disadvantaged employment categories, in addition to the elderly. Distance from hospital was inversely correlated with the hospitalisation rate. A formula for determining capitation can be developed using age and indirect factors of need as weights.