A&F effectiveness in reducing avoidable health differences: Equity issues & COVID 19

BACKGROUND: Healthcare equity aims to ensure that everyone can access affordable, culturally competent healthcare since everyone has a fair and just opportunity to attain their highest level of health. Italian National Health Service is characterized by the principles of universality and equality with the aim of the progressive overcoming of inequalities and social and territorial imbalances. The development of the principle of equality has made it possible to focus on three different areas in which the corollary of equity must find concrete implementation: access to health benefits and services, health outcomes for individual subjects, and the allocation of resources and services as needed. Key performance indicators (KPIs) are described as essential in studying and enhancing healthcare performance. METHODS: Within the network project EASY-NET (NET code 2016-02364191), we carried out an A&F study in Friuli Venezia Giulia region, Italy, over 4 years, evaluating the equity of emergency healthcare access. We calculated 6 KPIs investigating gender, education, residence, and nationality using administrative health databases. We calculated and compared 2019, 2020, and 2021 KPIs. RESULTS: We observed a reduction in emergency care access during the pandemic, greater among women than among men, as reported in the literature, and an increase in access among citizens with ‘not detected/no qualification’ scholarship level and citizens with non-EU or not detected country of birth. CONCLUSIONS: Consistently with the literature, since the beginning of the pandemic, the population turned less to emergency health services, above all women. On the other hand, and contextually no-level-of-schooling citizens and non-EU-birth citizens turned more compared to the rest of the population. While healthcare systems were focused on COVID-19, a worrying reduction in access to care was observed, bringing attention to the issue of healthcare equity both during and post COVID. KEY MESSAGES: • We observed a reduction of healthcare access in the emergency context, above all for women, since the pandemic began. • Non-EU-birth citizens and citizens with no level of schooling had more frequent access to emergency health services than the rest of the population in the pandemic context.