169,734 research outputs found
How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy
No full textL'impiego di neurolettici atipici in pazienti con doppia diagnosi di schizofrenia e abuso di cannabis: dati clinici con olanzapina
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International Comparison of Public Sector Performance: The Use of Anchoring Vignettes to adjust Self-Reported Data
No full textInternational comparison of performance has become an influential lever for change in the provision of public services. For health care, patients' views and opinions are increasingly being recognized as legitimate means for assessing the provision of services, to stimulate quality improvements, and more recently, in evaluating system performance. This has shifted the focus of analyses towards the use of individual-level surveys of performance from the perspective of the user and raises the issue of how to compare appropriately self-reported data across institutional settings and population groups. Using data on health systems responsiveness across 17 EU countries contained within the World Health Survey, this paper outlines the issues that arise in comparative inference that relies on respondent self-reports. The problem of systematic reporting behaviour is described and illustrated together with potential solutions brought about through the use of anchoring vignettes. Our results show large differences in the rankings of country performance once adjustment for systematic country-level reporting behaviour has been undertaken compared to the ranking observed in the raw unadjusted data. The use of anchoring vignettes as a means to obtain comparability in self-reported survey instruments of performance promises to be a fundamental tool for international comparative research
Vignettes and health systems responsiveness in cross-country comparative analyses
No full textThe paper explores the use of anchoring vignettes as a means to adjust survey reports of health system performance for differential reporting behaviour by using data contained within the World Health Survey. Survey respondents are asked to rate their experiences of health systems across a number of domains on a five-point categorical scale. Using data provided through a set of vignettes we investigate variations in reporting of interactions with health services across both sociodemographic groups and countries. We show how the method of anchoring vignettes can be used to enhance cross-country comparability of performance. Our results show large changes in the rankings of country performance once adjustment for systematic country level reporting behaviour has been undertaken compared with a ranking based on raw unadjusted data
Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy
No full textRecent theories on fiscal decentralization support the view that sub-national governments who finance a larger share of their spending with taxes raised locally by themselves are more accountable towards their citizens. Whilst evidence on improvements in spending efficiency is relatively common, little is known about the effects on inequalities amongst the population. In this paper we exploit a reform aimed at increasing regional tax autonomy in Italy to provide quasi-experimental evidence on the impact of fiscal decentralization on health disparities between- and within-regions. Our findings, robust to a number of robustness checks, support the view that fiscal decentralization does not impact on between-regional inequalities but can help to reduce inequalities within regions. However, this last effect depends on the degree of economic development: richer regions are better than poorer ones in containing inequalities
The geography of hospital admission in a national health service with patient choice
No full textEach year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for ‘trade’ in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enroless for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool. Copyright (C) 2010 John Wiley & Sons, Ltd.patients' mobility , hospital care , gravity model , spatial filtering , Italian National Health Service ,
Well-Being and Psychological Consequences of Temporary Contracts: The Case of Younger Italian Employees
No full textWorking conditions in Western countries have changed dramatically in the last twenty years, witnessing the emergence of new forms of employment contracts. The number of "standard" fulltime permanent jobs has decreased, while non-standard work arrangements such as temporary, contingent or part-time contracts have become much more common. This paper analyses the impact of temporary contracts and job insecurity on well-being among younger Italian employees. We use the "Health Conditions and Use of the Health Service Survey" carried out by the Italian National Institute of Statistics in conjunction with the Bank of Italy's Survey on Households Income and Wealth (SHIW). We consider four dimensions of individual well-being: physical health, mental health, self-assessed health and happiness. To account for individual heterogeneity we match each temporary worker with a permanent worker using propensity score matching. Well-being of matched individuals is compared to estimates of the average effect of working with a temporary as opposed to a permanent contract. Our analysis reveals a negative relationship between psychological well-being, happiness and having a temporary job and is particularly marked for male
Insecure, sick and unhappy? Well-being consequences of temporary employment contracts
No full textThis paper investigates the influences of temporary contracts along several dimensions of well-being (physical and mental health, self-assessed health and happiness) for young Italian workers. Our paper contributes to the literature exploring some new aspects of the relationship between temporary jobs and well-being in a country not frequently analysed in previous literature. We focus on the gender gap in the well-being consequences of non-permanent jobs, the influence of financial support by family in reducing well-being effects caused by temporary contracts and the interaction between gender gap and family support
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