1,720,974 research outputs found
Identification of spatial regimes of the production function of Italian hospitals through spatially constrained cluster-wise regression
Full text linkBuilding on the idea that different hospitals may operate with different technologies, the objective of this paper is a spatial characterization of the production function of hospital services through the identification of different spatial regimes. We introduce an original methodology to identify spatially constrained regimes, namely spatially constrained portions of territory in which the production units are maximally homogeneous in functional terms. The empirical algorithm can be described as a k-means cluster-wise regression procedure in which the units are belonging to a proximity graph and where distance is assessed in regressive terms. The analysis is implemented, first, on simulated data and, then, on output and input data of Italian hospitals for the year 2010. Our results, besides their methodological value, allow to shed light on the working of the hospital sector in Italy. The heterogeneity of the identified technological regimes can be associated to spatial heterogeneity of relevant aspects, like demand, internal organization, clinical and managerial governance, etc., and consequential policy implications can be, therefore, gathered
Linking the Price of Cancer Drug Treatments to Their Clinical Value
No full textBACKGROUND AND OBJECTIVE:
Appropriate pricing of medications is one of the ultimate goals for decision makers, but reliable data on the risk/benefit ratio are often lacking when a Marketing Authorization Application is submitted. Here we propose a method to consistently evaluate price adequacy, which we applied to six anticancer medications approved in Italy in recent years.
METHODS:
We obtained ratios of cost per survival per day (cost/survival/day) by dividing the total costs of evaluated medications for the median survival gain in days. Each cost/survival/day corresponds to a crude score, with 0 assigned to a cost/survival/day ≥€586. The maximum price considered as adequate was €91 cost/survival/day (score 75) while a score of 100 corresponded to a cost/survival/day ≤€11, based on the thresholds set by the British National Health System (NHS) and the "willingness-to-pay" of the Italian NHS. Crude scores were then adjusted using correction factors for efficacy, safety, quality of life, and prevalence of disease.
RESULTS:
None of the analyzed medications (abiraterone, afatinib, aflibercept, bevacizumab, dabrafenib, and ipilimumab) achieved a final score of 75, corresponding to adequate pricing. The final score for afatinib was the highest with 55 points. Prices of all the other drugs resulted in being inadequate, with negative final scores for bevacizumab, dabrafenib, and ipilimumab.
CONCLUSIONS:
This method may be considered a tool for the evaluation of appropriateness of price proposed at negotiation and could represent a reliable resource for decision-making. Furthermore, this analysis suggests that most recently approved cancer drugs in Italy do not fulfill price adequacy
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
Identification of spatially constrained homogeneous clusters of COVID‐19 transmission in Italy
No full textThis paper introduces an approach to identify a set of spatially constrained homogeneous areas that are maximally homogeneous in terms of epidemic trends. The proposed hierarchical algorithm is based on the dynamic time warping distances between epidemic time trends, where units are constrained by a spatial proximity graph. Two different applications of this approach to Italy are presented, based on different data (number of positive tests and number of differential deaths with respect to previous years) and different observational units observed at different spatial scales (provinces and labour market areas). The provincial analysis was mainly used to divide the national territory into macro-areas with different contagion trends, while the more detailed partition was carried out only for the macro-areas with higher risk of transmission of the infection. Both applications, above all that related to labour market areas, show the existence of well-defined areas where the dynamics of growth of the infection have been strongly differentiated. The adoption of the same lockdown policy throughout the entire national territory has been therefore sub-optimal, highlighting once again the urgent need for local data-driven policies
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
Spatial heterogeneity in non-parametric efficiency: An application to Italian hospitals
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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