[Intra-moenia: a historical and economical research].

Abstract

The so called free practice intra-moenia or ALPI (to be performed inside the public premises) is very popular among Italian doctors (quite so among patients). Our work aims to shed light both on true motives of such a success and on the degree of accomplishment of stated targets at its institution. We believe that its success among doctors is due both to the increase in providers' autonomy and to its economic advantages. Freedom of choice for patients is also increased (though just a minority of patients says that they have made recourse to intra-moenia because they wanted to choose the doctor). The reduction of queues, one of the stated targets of ALPI, did not happen (as could be anticipated). Intra-moenia may cause, moreover, induction of demand and defensive medicine. A regression analysis shows that the main explanatory factor of the recourse to ALPI is urgent need for treatment. The work, finally, in noting that there is a lack of sufficient administrative controls on ALPI, concludes that intra-moenia is hopefully a viable institution provided that more checks are done.