1,720,981 research outputs found
Perchè alcuni comuni hanno più nidi di altri?
No full textL'articolo propone un'analisi della situazione italiana in tema di servizi locali all'infanzia mettendo in evidenza realtà differenti tra nord e sud, ma sempre distanti dagli standard previsti dal Trattato di Lisbon
Assessing Types of Fiscal Rules
No full textWe evaluate the impact of dierent sub-national scal rules on budget outcomes
in a quasi-experimental setup. In 1999 the Italian central government introduced sub-
national scal rules aimed at imposing a scal discipline on the municipalities and
facilitate the coordination of the local public nance with the national one. Since
then every year the national government sets both requirements and targets of the
rules, alternatively, expenditures' caps and budget balance rules. Using data at the
municipal level, we test the impact of shifting from one rule to the other, given that
the shift did not take place for all municipalities in our sample at the same time. Our
results show that a shift to the expenditures' cap rule produce a decrease in current
expenditures, with no consequences on other budget outcome variables
Livelli essenziali delle prestazioni: aspetti teorici e spunti di riflessione
No full textAnche in contesti decentralizzati, le decisioni allocative locali spesso risentono di politiche stabilite a livello centrale. E' questa la logica di standard minimi quantitativi e qualitativi di alcuni insiemi di servizi offerti a livello locale.Il nostro contributo si focalizza sul dibattito italiano circa la fissazione dei livelli essenziali delle prestazioni con particolare riferimento ai servizi locali all'infanzia
Delays in medical malpractice litigation in civil law jurisdictions: Some evidence from the Italian Court of Cassation
No full textMedical malpractice law and tort reform are contentious issues. In this paper, we focus on Italy as an example of a civil law jurisdiction. Italian medical malpractice law is essentially judge-made law. However, its effectiveness is likely to be curtailed by excessive delays in litigation. Several reforms have been enacted since the late 1980s to correct this situation. By making use of the decisions of the Italian Court of Cassation (which have shaped medical malpractice law) from 1970 to 2009, we show that these reforms had no general statistically significant impact on delays. Recent reduction of delays does not seem to be related to legal reforms but rather explained by other factors
Curb your premium: the impact of monitoring malpractice claims
No full textWe study a policy aimed at increasing the level of information on medical malpractice costs and the risk exposure of local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the level of government that rules providers in a multilevel institutional setting. In particular, we implement a difference-in-differences strategy using Italian data at the provider level from 2001 to 2008 to evaluate the impact of monitoring claims on medical liability expenditures, measured as insurance premiums and legal expenditures, which was adopted by only some Regions. Our results show that this information-enhancing policy reduces paid premiums by around 15%. This reduced-form effect might arise by higher bargaining power on the demand side or increased competition on the supply side of the insurance market. Validity tests show that our findings are not driven by differential pre-policy trends between treated and control providers. Moreover, this policy could be cheaply implemented also in other institutional contexts with positive effects
‘No Win, No Fee’, Cost-shifting and the Costs of Civil Litigation : A Natural Experiment
Full text linkExpenditure on legal services has been rising and has attracted considerable policy attention in the UK. We argue that an important reason for this increase stems from the introduction of ‘no win no fee’ schemes in 1995 and a subsequent amendment's in 2000 which allowed claimants to shift additional costs onto losing defendants. We describe how this may have increased expenditure on legal claims and we test for the 2000 amendment effect using a regression discontinuity design on a dataset of employers’ liability claims. We find that costs increased by approximately 25% post 2000, consistent with our theoretical predictions
Malpractice risk and medical treatment selection
Full text linkWe study how legal and financial incentives affect medical decisions. Using patient-level data from Italy, we identify the effect of a change in medical liability pressure by exploiting the geographical distribution of hospitals across court districts, where some districts increase the predictability of expected damages per injury while others do not. Using a difference-in-differences identification strategy, we show that as certainty of compensation increases, c-sections increase by 6.5 percentage points. There is no statistically significant effect on secondary health outcomes of either mothers or newborns, but the increase is higher for low-risk than high-risk mothers. The increase is driven by hospitals that have lower quality, are governed by inefficient court districts, face lower expected damages, and are paid more per c-section
The political economy of diagnosis-related groups
No full textA well-established political economic literature has shown as multi-level governance affects the inefficiency of public expenditures. Yet, this expectation has not been empirically tested on health expenditures. We provide a political economy interpretation of the variation in the prices of 6 obstetric DRGs using Italy as a case study. Italy offers a unique institutional setting since its 21 regional governments can decide whether to adopt the national DRG system or to adjust/waive it. We investigate whether the composition and characteristics of regional governments do matter for the average DRG level and, if so, why. To address both questions, we first use a panel fixed effects model exploiting the results of 66 elections between 2000 and 2013 (i.e., 294 obs) to estimate the link between DRGs and the composition and characteristics of regional governments. Second, we investigate these results exploiting the implementation of a budget constraint policy through a difference-in-differences framework. The incidence of physicians in the regional government explains the variation of DRGs with low technological intensity, such as normal newborn, but not of those with high technological intensity, as severely premature newborn. We also observe a decrease in the average levels of DRGs after the budget constraint implementation, but the magnitude of this decrease depends primarily on the presence of physicians among politicians and the political alignment between the regional and the national government. To understand which kind of role the relevance of the political components plays (i.e., waste vs. better defined DRGs), we check whether any of the considered political economy variables have a positive impact on the quality of regional obstetric systems finding no effect. These results are a first evidence that a system of standardized prices, such as the DRGs, is not immune to political pressures
The life-saving effect of hospital proximity
No full textWe provide a new assessment of the effect of hospital proximity in an emergency situationroad-traffic accidentsexploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital on the basis of their population size. Our instrumental variable results show that a one-standard-deviation increase in the distance to the nearest hospital (5km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both ordinary least squares and difference-in-differences estimates, common approaches in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards
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