Federico Toth

Health care universalism on paper and in reality

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This article investigates - at first from a comparative perspective and then focusing on the Italian case - the issue of universal health coverage. This concept is «unpacked» in two different dimensions, namely the diffusion of health insurance coverage and the generosity of the insurance package. The first part of the article consists of the comparative analysis of health coverage diffusion among EU and OECD member states. Over the last four decades, the number of countries providing health care coverage to the entire population has gradually increased. In addition to the diffusion of health coverage, the generosity of insurance schemes is also taken into account. To this end, two indicators can be used: 1) out-of-pocket health expenditure; 2) the so-called «unmet medical needs». With reference to these indicators, some countries - including Italy - can be classified as «universal but ungenerous». The second part of the article focuses on the Italian case, analyzing in particular the barriers which hinder effective access to health care services.


  • Universal Health Coverage
  • Health Insurance
  • Access to Health Services
  • Unmet Medical Needs
  • Italian National Health Service


Article first page

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