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Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy

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  • Seghieri, Chiara
  • Berta, Paolo
  • Nuti, Sabina

Abstract

Geographic variations in healthcare expenditures have been widely reported within and between countries. Nevertheless, empirical evidence on the role of organizational factors and care systems in explaining these variations is still needed. This paper aims at assessing the regional differences in hospital spending for patients hospitalized for Acute Myocardial Infarction (AMI) in Tuscany and Lombardy regions (Italy), which rank high in terms of care quality and that have been, at least until 2016, characterized by quite different governance systems. Generalized linear models are performed to estimate index, 30-day and one-year hospitalization spending adjusted for baseline covariates. A two-part model is used to estimate 31–365 day expenditure. Adjusted hospital spending for AMI patients were significantly higher in Lombardy compared with Tuscany. In Lombardy, patients experienced higher re-hospitalizations in the 31–365 days and longer length of stays than in Tuscany. On the other hand, no significant regional differences in adjusted mortality rates at both acute and longer phases were found.

Suggested Citation

  • Seghieri, Chiara & Berta, Paolo & Nuti, Sabina, 2019. "Geographic variation in inpatient costs for Acute Myocardial Infarction care: Insights from Italy," Health Policy, Elsevier, vol. 123(5), pages 449-456.
  • Handle: RePEc:eee:hepoli:v:123:y:2019:i:5:p:449-456
    DOI: 10.1016/j.healthpol.2019.01.010
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    1. Glick, Henry A. & Doshi, Jalpa A. & Sonnad, Seema S. & Polsky, Daniel, 2014. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, edition 2, number 9780199685028, Decembrie.
    2. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    3. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June.
    4. John Mullahy, 1998. "Much Ado About Two: Reconsidering Retransformation and the Two-Part Model in Health Economics," NBER Technical Working Papers 0228, National Bureau of Economic Research, Inc.
    5. Willard Manning, 2012. "Dealing with Skewed Data on Costs and Expenditures," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 44, Edward Elgar Publishing.
    6. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    7. Zhenwei Li & Yijiang Zhou & Qingqing Xu & Xiaomin Chen, 2017. "Staged versus One-Time Complete Revascularization with Percutaneous Coronary Intervention in STEMI Patients with Multivessel Disease: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-15, January.
    8. Nuti, Sabina & Vainieri, Milena & Bonini, Anna, 2010. "Disinvestment for re-allocation: A process to identify priorities in healthcare," Health Policy, Elsevier, vol. 95(2-3), pages 137-143, May.
    9. Nuti, Sabina & Vola, Federico & Bonini, Anna & Vainieri, Milena, 2016. "Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 17-38, January.
    10. Klim McPherson & Giorgia Gon & Maggie Scott, 2013. "International Variations in a Selected Number of Surgical Procedures," OECD Health Working Papers 61, OECD Publishing.
    11. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2011. "Multivariate Matching Methods That Are Monotonic Imbalance Bounding," Journal of the American Statistical Association, American Statistical Association, vol. 106(493), pages 345-361.
    12. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
    13. Bevan, Gwyn & Evans, Alice & Nuti, Sabina, 2018. "Reputations count: why benchmarking performance is improving health care across the world," LSE Research Online Documents on Economics 86469, London School of Economics and Political Science, LSE Library.
    14. David Cutler & Jonathan Skinner & Ariel Dora Stern & David Wennberg, 2013. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," NBER Working Papers 19320, National Bureau of Economic Research, Inc.
    15. Weeks, William B. & Paraponaris, Alain & Ventelou, Bruno, 2014. "Geographic variation in rates of common surgical procedures in France in 2008–2010, and comparison to the US and Britain," Health Policy, Elsevier, vol. 118(2), pages 215-221.
    16. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    17. Richard Heijink & Peter Engelfriet & Clas Rehnberg & Sverre A. C. Kittelsen & Unto Häkkinen & on behalf of the EuroHOPE study group, 2015. "A Window on Geographic Variation in Health Care: Insights from EuroHOPE," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 164-177, December.
    18. Sverre A. C. Kittelsen & Kjartan S. Anthun & Fanny Goude & Ingrid M. S. Huitfeldt & Unto Häkkinen & Marie Kruse & Emma Medin & Clas Rehnberg & Hanna Rättö & on behalf of the EuroHOPE study group, 2015. "Costs and Quality at the Hospital Level in the Nordic Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 140-163, December.
    19. Corallo, Ashley N. & Croxford, Ruth & Goodman, David C. & Bryan, Elisabeth L. & Srivastava, Divya & Stukel, Therese A., 2014. "A systematic review of medical practice variation in OECD countries," Health Policy, Elsevier, vol. 114(1), pages 5-14.
    20. Paolo Berta & Gianmaria Martini & Francesco Moscone & Giorgio Vittadini, 2016. "The association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 907-926, October.
    21. Häkkinen, Unto & Rosenqvist, Gunnar & Peltola, Mikko & Kapiainen, Satu & Rättö, Hanna & Cots, Francesc & Geissler, Alexander & Or, Zeynep & Serdén, Lisbeth & Sund, Reijo, 2014. "Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals," Health Policy, Elsevier, vol. 117(1), pages 15-27.
    22. Peter C. Austin & Jack V. Tu, 2006. "Comparing clinical data with administrative data for producing acute myocardial infarction report cards," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 169(1), pages 115-126, January.
    23. Paolo Berta & Chiara Seghieri & Giorgio Vittadini, 2013. "Comparing health outcomes among hospitals: the experience of the Lombardy Region," Health Care Management Science, Springer, vol. 16(3), pages 245-257, September.
    24. Eugenio Anessi-Pessina & Elena Cantù & Claudio Joninii, 2004. "Phasing Out Market Mechanisms in the Italian National Health Service," Public Money & Management, Taylor & Francis Journals, vol. 24(5), pages 309-316, October.
    25. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2012. "Causal Inference without Balance Checking: Coarsened Exact Matching," Political Analysis, Cambridge University Press, vol. 20(1), pages 1-24, January.
    26. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
    27. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
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    1. Miszczyńska Katarzyna M. & Miszczyński Piotr M., 2020. "Inpatient Costs in the Perspective of Polish Health Policy: Scenario Analysis," South East European Journal of Economics and Business, Sciendo, vol. 15(2), pages 43-56, December.
    2. Małgorzata Cygańska & Magdalena Kludacz-Alessandri & Chris Pyke, 2023. "Healthcare Costs and Health Status: Insights from the SHARE Survey," IJERPH, MDPI, vol. 20(2), pages 1-14, January.
    3. Sabina Nuti & Guido Noto & Tommaso Grillo Ruggieri & Milena Vainieri, 2021. "The Challenges of Hospitals’ Planning & Control Systems: The Path toward Public Value Management," IJERPH, MDPI, vol. 18(5), pages 1-14, March.
    4. De Rosis, Sabina & Guidotti, Elisa & Zuccarino, Sara & Venturi, Giulia & Ferré, Francesca, 2020. "Waiting time information in the Italian NHS: A citizen perspective," Health Policy, Elsevier, vol. 124(8), pages 796-804.

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