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Exploring health outcomes by stochastic multicriteria acceptability analysis: An application to Italian regions

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  • Lagravinese, Raffaele
  • Liberati, Paolo
  • Resce, Giuliano

Abstract

This paper introduces the Stochastic Multicriteria Acceptability Analysis (SMAA) in order to investigate the evolution of mortality rates in the Italian regions over the period 1990–2013. We propose to explore the overall outcome of health care by a Composite Index of mortality based on the combination of standardized mortality rates for seventeen different diseases. From a methodological standpoint, we propose to overcome the arbitrary nature of the weighting process, by using the SMAA, which is a methodology that allows to rank regions considering the whole set of possible vectors of weights. Moreover, we explore the spatial segregation in health using the multidimensional generalization of the Gini index, and introduce the multidimensional generalization of ANOGI. The unprecedented use of SMAA in evaluating the health sector allows to explore regional multidimensional paths beyond the order of importance given to the single dimensions. Our analysis shows that in the 24 years considered there has been no convergence path in terms of health care outcome in Italy, neither between nor within regions.

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  • Lagravinese, Raffaele & Liberati, Paolo & Resce, Giuliano, 2019. "Exploring health outcomes by stochastic multicriteria acceptability analysis: An application to Italian regions," European Journal of Operational Research, Elsevier, vol. 274(3), pages 1168-1179.
    • Handle: RePEc:eee:ejores:v:274:y:2019:i:3:p:1168-1179
    DOI: 10.1016/j.ejor.2018.11.009
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    1. Carinci, Fabrizio & Caracci, Gianni & Di Stanislao, Francesco & Moirano, Fulvio, 2012. "Performance measurement in response to the Tallinn Charter: Experiences from the decentralized Italian framework," Health Policy, Elsevier, vol. 108(1), pages 60-66.
    2. Lahdelma, Risto & Salminen, Pekka & Hokkanen, Joonas, 2002. "Locating a waste treatment facility by using stochastic multicriteria acceptability analysis with ordinal criteria," European Journal of Operational Research, Elsevier, vol. 142(2), pages 345-356, October.
    3. Cappellaro, Giulia & Fattore, Giovanni & Torbica, Aleksandra, 2009. "Funding health technologies in decentralized systems: A comparison between Italy and Spain," Health Policy, Elsevier, vol. 92(2-3), pages 313-321, October.
    4. Zeynep Or, 2001. "Exploring the Effects of Health Care on Mortality Across OECD Countries," OECD Labour Market and Social Policy Occasional Papers 46, OECD Publishing.
    5. Paolo Liberati, 2015. "The World Distribution of Income And Its Inequality, 1970–2009," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 61(2), pages 248-273, June.
    6. Tervonen, Tommi & Lahdelma, Risto, 2007. "Implementing stochastic multicriteria acceptability analysis," European Journal of Operational Research, Elsevier, vol. 178(2), pages 500-513, April.
    7. Branko Milanovic & Shlomo Yitzhak, 2006. "Decomposing World Income Distribution: Does The World Have A Middle Class?," IBT Journal of Business Studies (JBS), Ilma University, Faculty of Management Science, vol. 2(2), pages 88-110.
    8. Iñaki Permanyer, 2011. "Assessing The Robustness Of Composite Indices Rankings," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 57(2), pages 306-326, June.
    9. Vincenzo Patrizii & Anna Pettini & Giuliano Resce, 2017. "The Cost of Well-Being," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 985-1010, September.
    10. Yitzhaki, Shlomo & Lerman, Robert I, 1991. "Income Stratification and Income Inequality," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 37(3), pages 313-329, September.
    11. Floridi, Matteo & Pagni, Simone & Falorni, Simone & Luzzati, Tommaso, 2011. "An exercise in composite indicators construction: Assessing the sustainability of Italian regions," Ecological Economics, Elsevier, vol. 70(8), pages 1440-1447, June.
    12. Lahdelma, Risto & Hokkanen, Joonas & Salminen, Pekka, 1998. "SMAA - Stochastic multiobjective acceptability analysis," European Journal of Operational Research, Elsevier, vol. 106(1), pages 137-143, April.
    13. Francesco Porcelli, 2014. "Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms," Economics of Governance, Springer, vol. 15(3), pages 221-251, August.
    14. Shlomo Yitzhaki & Edna Schechtman, 2009. "The “melting pot”: A success story?," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 7(2), pages 137-151, June.
    15. Angilella, Silvia & Corrente, Salvatore & Greco, Salvatore & Słowiński, Roman, 2016. "Robust Ordinal Regression and Stochastic Multiobjective Acceptability Analysis in multiple criteria hierarchy process for the Choquet integral preference model," Omega, Elsevier, vol. 63(C), pages 154-169.
    16. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.
    17. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    18. Sen, Amartya, 1998. "Mortality as an Indicator of Economic Success and Failure," Economic Journal, Royal Economic Society, vol. 108(446), pages 1-25, January.
    19. Bottero, M. & Ferretti, V. & Figueira, J.R. & Greco, S. & Roy, B., 2015. "Dealing with a multiple criteria environmental problem with interaction effects between criteria through an extension of the Electre III method," European Journal of Operational Research, Elsevier, vol. 245(3), pages 837-850.
    20. Pyatt, Graham, 1976. "On the Interpretation and Disaggregation of Gini Coefficients," Economic Journal, Royal Economic Society, vol. 86(342), pages 243-255, June.
    21. Yitzhaki, Shlomo, 1994. "Economic distance and overlapping of distributions," Journal of Econometrics, Elsevier, vol. 61(1), pages 147-159, March.
    22. Raffaela Giordano & Pietro Tommasino, 2013. "Public-Sector Efficiency and Political Culture," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 69(3), pages 289-316, September.
    23. Angilella, Silvia & Mazzù, Sebastiano, 2015. "The financing of innovative SMEs: A multicriteria credit rating model," European Journal of Operational Research, Elsevier, vol. 244(2), pages 540-554.
    24. Joachim R. Frick & Jan Goebel & Edna Schechtman & Gert G. Wagner & Shlomo Yitzhaki, 2006. "Using Analysis of Gini (ANOGI) for Detecting Whether Two Subsamples Represent the Same Universe," Sociological Methods & Research, , vol. 34(4), pages 427-468, May.
    25. Laurens Cherchye & Willem Moesen & Nicky Rogge & Tom Puyenbroeck, 2007. "An Introduction to ‘Benefit of the Doubt’ Composite Indicators," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 82(1), pages 111-145, May.
    26. Cohen, Sandra & Doumpos, Michael & Neofytou, Evi & Zopounidis, Constantin, 2012. "Assessing financial distress where bankruptcy is not an option: An alternative approach for local municipalities," European Journal of Operational Research, Elsevier, vol. 218(1), pages 270-279.
    27. Ferrario, Caterina & Zanardi, Alberto, 2011. "Fiscal decentralization in the Italian NHS: What happens to interregional redistribution?," Health Policy, Elsevier, vol. 100(1), pages 71-80, April.
    28. Risto Lahdelma & Pekka Salminen, 2001. "SMAA-2: Stochastic Multicriteria Acceptability Analysis for Group Decision Making," Operations Research, INFORMS, vol. 49(3), pages 444-454, June.
    29. Salvatore Greco & Alessio Ishizaka & Menelaos Tasiou & Gianpiero Torrisi, 2019. "On the Methodological Framework of Composite Indices: A Review of the Issues of Weighting, Aggregation, and Robustness," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 141(1), pages 61-94, January.
    30. Doumpos, Michael & Hasan, Iftekhar & Pasiouras, Fotios, 2017. "Bank overall financial strength: Islamic versus conventional banks," Economic Modelling, Elsevier, vol. 64(C), pages 513-523.
    31. Vincenzo Patrizii & Giuliano Resce, 2015. "Public Sector Contribution To Competitiveness," Italian Economic Journal: A Continuation of Rivista Italiana degli Economisti and Giornale degli Economisti, Springer;Società Italiana degli Economisti (Italian Economic Association), vol. 1(3), pages 401-443, November.
    32. Milanovic, Branko & Yitzhaki, Shlomo, 2002. "Decomposing World Income Distribution: Does the World Have a Middle Class?," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 48(2), pages 155-178, June.
    33. Menou, Abdellah & Benallou, Abdelhanine & Lahdelma, Risto & Salminen, Pekka, 2010. "Decision support for centralizing cargo at a Moroccan airport hub using stochastic multicriteria acceptability analysis," European Journal of Operational Research, Elsevier, vol. 204(3), pages 621-629, August.
    34. Shlomo Yitzhaki & Robert I. Lerman, 1991. "Income Stratification And Income Inequality," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 37(3), pages 313-329, September.
    35. Emma Medin & Fanny Goude & Hans Olav Melberg & Fabrizio Tediosi & Eva Belicza & Mikko Peltola, 2015. "European Regional Differences in All‐Cause Mortality and Length of Stay for Patients with Hip Fracture," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 53-64, December.
    36. Raffaele Lagravinese & Paolo Liberati & Agnese Sacchi, 2018. "The growth and variability of regional taxes: an application to Italy," Regional Studies, Taylor & Francis Journals, vol. 52(3), pages 416-429, March.
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    7. Vikas Kumar Mishra & Bapi Dutta & Mark Goh & José Rui Figueira & Salvatore Greco, 2021. "A robust ranking of maritime connectivity: revisiting UNCTAD’s liner shipping connectivity index (LSCI)," Maritime Economics & Logistics, Palgrave Macmillan;International Association of Maritime Economists (IAME), vol. 23(3), pages 424-443, September.
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    13. Caravaggio, Nicola & Resce, Giuliano, 2023. "Enhancing Healthcare Cost Forecasting: A Machine Learning Model for Resource Allocation in Heterogeneous Regions," Economics & Statistics Discussion Papers esdp23090, University of Molise, Department of Economics.
    14. Carnazza, Giovanni & Liberati, Paolo & Resce, Giuliano, 2023. "Income-related unmet needs in the European countries," Socio-Economic Planning Sciences, Elsevier, vol. 87(PA).
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    More about this item

    Keywords

    OR in health services; Stochastic multicriteria acceptability Analysis; Composite indicators; Spatial inequality; ANOGI;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • C44 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Operations Research; Statistical Decision Theory

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