1,720,981 research outputs found
Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS
No full textIn recent decades, austerity measures have been widely adopted in public healthcare systems, so as to cope with financial constraints. This paper assesses the impact of a specific austerity policy implemented in Italy since 2007, with the purpose of reducing the budget deficit of regional governments originated by an excessive healthcare expenditure, the so called Recovery Plans (Piani di rientro). We exploit this context for a counterfactual analysis of the effects of Recovery Plans on the technical efficiency of hospitals operating in the regions where the Plans have been implemented, using as a control group similar hospitals in the regions where the policies were not enacted. The empirical analysis is based on a unique sample of administrative data relative to a large panel of hospitals in the period 2003–2010, and it employs, as identification strategy, the exogenous introduction of the austerity policy in some regions. We find that the policy had a detrimental effect on the efficiency of the hospitals operating in the regions subjected to the policy. The results show that the efficiency loss grows over time, suggesting the existence of negative cumulative effects of the austerity policy
How does institutional quality affect the efficiency of local government? An assessment of Italian municipalities
No full textDoes neighbours’ grass matter? Testing spatial dependent heterogeneity in technical efficiency of Italian hospitals
No full textTesting for spatial dependent heterogeneity in hospital technical efficiency is crucial for separating spatial issues from the effects of regional institutional factors. We apply the Spatial Stochastic Frontier Analysis for studying the presence of spatial dependence by using novel data on Italian hospitals. This approach provides both a robust estimation of hospital technical efficiency and a careful assessment of spatial and regional issues. We find empirical support for the idea that regional and institutional factors are more important than neighbouring ef-fects when looking at heterogeneity in hospital technical efficiency across Italy. The relevance of the regional organization of the Italian hospital system can justify our results. We also discuss the limitations of our analysis and provide sensitivity checks
Does neighbour’s grass matter? Exploring spatial dependent heterogeneity in technical efficiency of Italian hospitals
No full textWith respect to the other dimensions of hospital behaviour, studying the presence of interaction effects on efficiency involves the issue of which approach is most appropriate to incorporate the spatial dependence in the empirical efficiency model. Using a large sample of Italian hospitals, this paper explores the presence of spatial dependence in technical efficiency. To this purpose, we employ a Spatial Stochastic Frontier Analysis (SSFA) that allows us to robustly estimate the efficiency of each hospital while considering the presence of spatial dependence. Furthermore, we employ both standard spatial contiguity matrix and spatial matrixes exploring the idea of institutional contiguity. Overall, the results suggest an insignificant role for spatial dependence in the efficiency of Italian hospitals, regardless of the specific form of spatial dependence implicit in the weights matrix
One for all? Assessing the quality of Italian hospital care with the "benefit of the doubt" composite indicator methods
No full text: Quality assessment in healthcare systems is challenging due to the multidimensional nature of healthcare services. This study evaluates the overall quality provided by hospitals using composite indicators under the Benefit of the Doubt (BoD) approach, which determines the weights of the indicators with minimal assumptions. We used data from 2015-2020 for Italian Local Health Authorities (LHAs) for 21 outcome measures, applying various non-parametric methods to address aggregation and weighting challenges. Our results show that the BoD measures are robust and effectively capture the dynamics of the quality of LHA, even during external shocks such as the COVID-19 pandemic. This research highlights the importance of methodological choices in the construction of composite indicators and demonstrates the effectiveness of the BoD approach in providing a comprehensive measure of healthcare quality
Determinants of Heritage Authorities’ Performance: An exploratory study with DEA bootstrapping approach
Full text linkGovernment regulation plays a significant role in the field of heritage conservation. Namely, regulation is aimed at controlling the stock of heritage, restricting or modifying the activities of public as well as private actors. Surprisingly, the literature has neither extensively investigated the performance of the heritage authorities involved in the implementation of conservation policies nor its determinants. In this paper we address this issue, from a theoretical as well as an empirical perspective, using Sicily as a case study. More precisely, we analyze the determinants of the differences in the efficiency levels of conservation activity of the nine Sicilian heritage authorities over the period 1993-2005. Economic and managerial variables are used to distinguish non-discretionary from discretionary causes. The results show that the efficiency scores seem to be only affected by economic factors whereas the managerial variables do not affect the performance of heritage authorities.Heritage regulation, cultural policy, efficiency analysis.
Spatial heterogeneity in non-parametric efficiency: An application to Italian hospitals
Full text linkMeasuring Resilience and Fatality Rate During the First Wave of COVID-19 Pandemic in Northern Italy: A Note
No full textBackground: This Policy Brief aims to contribute to the debate on the resilience of the healthcare systems during the pandemic by discussing whether mortality indicators are appropriate for assessing resilience or whether other statistics should be employed. Evidence: During the first wave of the COVID-19, much emphasis was placed on case-fatality rates to offer a preliminary assessment of the resilience of healthcare systems. However, these statistics are often biased and do not consider the real figure of the population that has been infected. Policy Options and Recommendations: Comparing data obtained with different approaches based on statistical inference and large-scale serological survey, the brief highlights, that great care must be taken when using case-fatality data, which in the absence of careful analysis, can lead to erroneous conclusions. Conclusion: Using case-fatality rate gives us no sounding information about the real capability of healthcare systems to save lives during the pandemic. However, even in the absence of detailed epidemiological data new advancements in statistical methods can be useful to provide a more sounding evaluation of the resilience of the healthcare systems
Is Transparency a ‘Free Lunch’? Evidence from the Italian Local Health Authorities
Full text linkThe healthcare is often considered one of the sectors most prone to corruption, and transparency policies have been proposed in several countries to fight bribery and corruption. Indeed, the transparency of public bodies potentially plays a relevant role in preventing misbehaviour and favouring accountability. This study contributes to a broader understanding of the role of transparency in the healthcare sector using Italy as a case study. For this purpose, we first built a composite indicator to assess the differences in transparency, performance, and integrity between Italian local health authorities (LHAs) retrieving the administrative data available on their websites. Then, we used both non-parametric method and multivariate regression to explore the relationship between the performance of different expenditure functions (total production costs, administrative costs, and medical and non-medical-related service costs) at the LHA level and the transparency index. Our results show a wide difference in transparency, performance, and integrity among LHAs that does not always follow the classic north–south divide in Italy. In addition, we find results consistent with the idea that transparency is generally associated with a better capability of LHAs in the containment of healthcare expenditure while imposing larger administrative burdens. Overall, reforms promoting transparency impose administrative costs, which policymakers should bear in mind to develop less burdensome transparency measures, as they might not be a ‘free lunch’
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