IDEAS home Printed from https://ideas.repec.org/a/eee/soceps/v84y2022ics0038012122001835.html
   My bibliography  Save this article

How efficient is the Italian health system? Evidence on the role of political-institutional dynamics

Author

Listed:
  • Boffardi, Raffaele

Abstract

In a context of dwindling resources, an ageing population and increased costs for accessing technologies, improving healthcare systems efficiency has become a matter of great urgency. Public administrators play a crucial role in bringing about the efficient management of resources. Thus, it has become important to assess the efficiency of national health systems and to identify and eliminate inefficiencies in resource management. By exploiting a stochastic frontier analysis, the paper aims at assessing the determinants of health system efficiency in 20 Italian regions, between 2001 and 2018. Political and institutional factors affecting health sector performance have been identified. Italy has been chosen as a case study due to its decentralized structure and its assignment of decision-making roles to regional politicians and administrators. The main finding shows that institutional quality cannot be considered a marginal determinant, since it exerts a direct effect on healthcare systems' activities and an indirect influence on people's life quality.

Suggested Citation

  • Boffardi, Raffaele, 2022. "How efficient is the Italian health system? Evidence on the role of political-institutional dynamics," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    • Handle: RePEc:eee:soceps:v:84:y:2022:i:c:s0038012122001835
    DOI: 10.1016/j.seps.2022.101388
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0038012122001835
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.seps.2022.101388?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Cristian Barra & Raffaele Lagravinese & Roberto Zotti, 2022. "Exploring hospital efficiency within and between Italian regions: new empirical evidence," Journal of Productivity Analysis, Springer, vol. 57(3), pages 269-284, June.
    2. Halkos, George E. & Tzeremes, Nickolaos G., 2011. "A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures," Health Policy, Elsevier, vol. 103(1), pages 73-82.
    3. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    4. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
    5. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    6. Lisa Maria Dellmuth & Dominik Schraff & Michael F. Stoffel, 2017. "Distributive Politics, Electoral Institutions and European Structural and Investment Funding: Evidence from Italy and France," Journal of Common Market Studies, Wiley Blackwell, vol. 55(2), pages 275-293, March.
    7. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
    8. Atella, Vincenzo & Belotti, Federico & Bojke, Chris & Castelli, Adriana & Grašič, Katja & Kopinska, Joanna & Piano Mortari, Andrea & Street, Andrew, 2019. "How health policy shapes healthcare sector productivity? Evidence from Italy and UK," Health Policy, Elsevier, vol. 123(1), pages 27-36.
    9. Silvia Balia & Rinaldo Brau & Emanuela Marrocu, 2018. "Interregional patient mobility in a decentralized healthcare system," Regional Studies, Taylor & Francis Journals, vol. 52(3), pages 388-402, March.
    10. Ho Fai Chan & Martin Brumpton & Alison Macintyre & Jefferson Arapoc & David A Savage & Ahmed Skali & David Stadelmann & Benno Torgler, 2020. "How confidence in health care systems affects mobility and compliance during the COVID-19 pandemic," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-18, October.
    11. Joan Costa-Font & Gilberto Turati, 2018. "Regional healthcare decentralization in unitary states: equal spending, equal satisfaction?," Regional Studies, Taylor & Francis Journals, vol. 52(7), pages 974-985, July.
    12. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    13. Federico Belotti & Silvio Daidone & Giuseppe Ilardi & Vincenzo Atella, 2013. "Stochastic frontier analysis using Stata," Stata Journal, StataCorp LP, vol. 13(4), pages 718-758, December.
    14. Giuseppe Grossi & Daniela Pianezzi, 2018. "The new public corruption: Old questions for new challenges," Accounting Forum, Taylor & Francis Journals, vol. 42(1), pages 86-101, March.
    15. Margit Sommersguter-Reichmann & Claudia Wild & Adolf Stepan & Gerhard Reichmann & Andrea Fried, 2018. "Individual and Institutional Corruption in European and US Healthcare: Overview and Link of Various Corruption Typologies," Applied Health Economics and Health Policy, Springer, vol. 16(3), pages 289-302, June.
    16. 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.
    17. Alberto Alesina & Roberto Perotti, 1995. "The Political Economy of Budget Deficits," IMF Staff Papers, Palgrave Macmillan, vol. 42(1), pages 1-31, March.
    18. Rosella Levaggi & Roberto Zanola, 2004. "Patients' migration across regions: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 36(16), pages 1751-1757.
    19. Annamaria Nifo & Gaetano Vecchione, 2014. "Do Institutions Play a Role in Skilled Migration? The Case of Italy," Regional Studies, Taylor & Francis Journals, vol. 48(10), pages 1628-1649, October.
    20. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    21. Wang, Hung-Jen & Ho, Chia-Wen, 2010. "Estimating fixed-effect panel stochastic frontier models by model transformation," Journal of Econometrics, Elsevier, vol. 157(2), pages 286-296, August.
    22. repec:wly:hlthec:v:26:y:2017:i::p:5-22 is not listed on IDEAS
    23. Vincenzo Atella & Federico Belotti & Silvio Daidone & Giuseppe Ilardi & Giorgia Marini, 2012. "Cost-containment policies and hospital efficiency: evidence from a panel of Italian hospitals," CEIS Research Paper 228, Tor Vergata University, CEIS, revised 13 Apr 2012.
    24. Charalampos Economou & Claude Giorno, 2009. "Improving the Performance of the Public Health Care System in Greece," OECD Economics Department Working Papers 722, OECD Publishing.
    25. Cavalieri, Marina & Guccio, Calogero & Rizzo, Ilde, 2017. "On the role of environmental corruption in healthcare infrastructures: An empirical assessment for Italy using DEA with truncated regression approach," Health Policy, Elsevier, vol. 121(5), pages 515-524.
    26. Kashish TIBREWAL & Saswati CHAUDHURI, 2022. "Institutional quality and public healthcare," Theoretical and Applied Economics, Asociatia Generala a Economistilor din Romania - AGER, vol. 0(1(630), S), pages 63-82, Spring.
    27. Aleksander Aristovnik, 2015. "Efficiency of the Healthcare Sector in the EU-28 at the Regional Level," Managing Intellectual Capital and Innovation for Sustainable and Inclusive Society: Managing Intellectual Capital and Innovation; Proceedings of the MakeLearn and TIIM Joint International Conference 2,, ToKnowPress.
    28. Silvia Balia & Rinaldo Brau & Emanuela Marrocu, 2014. "What Drives Patient Mobility Across Italian Regions? Evidence from Hospital Discharge Data," Developments in Health Economics and Public Policy, in: Rosella Levaggi & Marcello Montefiori (ed.), Health Care Provision and Patient Mobility, edition 127, pages 133-154, Springer.
    29. Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.
    30. Wranik, Dominika, 2012. "Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD," Health Economics, Policy and Law, Cambridge University Press, vol. 7(2), pages 197-226, April.
    31. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2017. "Determinants of transient and persistent hospital efficiency: The case of Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 5-22, September.
    32. Katharina Schley, 2018. "Health care service provision in Europe and regional diversity: a stochastic metafrontier approach," Health Economics Review, Springer, vol. 8(1), pages 1-11, December.
    33. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health‐care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202, September.
    34. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.
    35. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    36. Raffaele Lagravinese & Massimo Paradiso, 2014. "Corruption and health expenditure in Italian Regions," Economics Bulletin, AccessEcon, vol. 34(3), pages 1498-1511.
    37. Silvio Daidone & Francesco D’Amico, 2009. "Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals," Journal of Productivity Analysis, Springer, vol. 32(3), pages 203-216, December.
    38. Luca Repetto, 2018. "Political Budget Cycles with Informed Voters: Evidence from Italy," Economic Journal, Royal Economic Society, vol. 128(616), pages 3320-3353, December.
    39. Andrea Riganti, 2021. "Containing costs in the Italian local healthcare market," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1001-1014, May.
    40. Francesco Grigoli & Javier Kapsoli, 2018. "Waste not, want not: The efficiency of health expenditure in emerging and developing economies," Review of Development Economics, Wiley Blackwell, vol. 22(1), pages 384-403, February.
    41. Roberta Arbolino & Raffaele Boffardi & Luisa De Simone, 2019. "Which are the Factors Influencing Innovation Performances? Evidence from Italian Cohesion Policy," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 146(1), pages 221-247, November.
    42. Greta Falavigna & Roberto Ippoliti, 2013. "L?efficienza dei sistemi sanitari regionali in Italia: pubblico o privato?," ECONOMIA E POLITICA INDUSTRIALE, FrancoAngeli Editore, vol. 2013(2), pages 29-49.
    43. Maura Francese & Marzia Romanelli, 2014. "Is there room for containing healthcare costs? An analysis of regional spending differentials in Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(2), pages 117-132, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rostand Arland Yebetchou Tchounkeu & Raffaella Santolini & Giulio Palomba & Elvina Merkaj, 2024. "Healthcare Efficiency And Elderly Mortality In Italy," Working Papers 485, Universita' Politecnica delle Marche (I), Dipartimento di Scienze Economiche e Sociali.
    2. Guccio, Calogero & Pignataro, Giacomo & Romeo, Domenica & Vidoli, Francesco, 2024. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).
    3. Guccio, Calogero & Pignataro, Giacomo & Romeo, Domenica & Vidoli, Francesco, 2024. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    2. Cristian Barra & Raffaele Lagravinese & Roberto Zotti, 2022. "Exploring hospital efficiency within and between Italian regions: new empirical evidence," Journal of Productivity Analysis, Springer, vol. 57(3), pages 269-284, June.
    3. Guccio, Calogero & Pignataro, Giacomo & Romeo, Domenica & Vidoli, Francesco, 2024. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).
    4. Angelo Castaldo & Maria Alessandra Antonelli & Valeria De Bonis & Giorgia Marini, 2020. "Determinants of health sector efficiency: evidence from a two-step analysis on 30 OECD countries," Economics Bulletin, AccessEcon, vol. 40(2), pages 1651-1666.
    5. Varabyova, Yauheniya & Müller, Julia-Maria, 2016. "The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons," Health Policy, Elsevier, vol. 120(3), pages 252-263.
    6. Ozbugday, Fatih Cemil & Tirgil, Abdullah & Kose, Elif Gul, 2020. "Efficiency changes in long-term care in OECD countries: A non-parametric Malmquist Index approach," Socio-Economic Planning Sciences, Elsevier, vol. 70(C).
    7. Rostand Arland Yebetchou Tchounkeu & Raffaella Santolini & Giulio Palomba & Elvina Merkaj, 2024. "Healthcare Efficiency And Elderly Mortality In Italy," Working Papers 485, Universita' Politecnica delle Marche (I), Dipartimento di Scienze Economiche e Sociali.
    8. Constantin Ogloblin, 2023. "Health care financing and productivity of health care in OECD countries: a stochastic frontier analysis," Eurasian Economic Review, Springer;Eurasia Business and Economics Society, vol. 13(2), pages 259-283, June.
    9. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    10. Alejandro Arvelo-Martín & Juan José Díaz-Hernández & Ignacio Abásolo-Alessón, 2019. "Hospital productivity bias when not adjusting for cost heterogeneity: The case of Spain," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-17, June.
    11. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    12. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
    13. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
    14. Gearhart Richard, 2019. "The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 19(2), pages 1-16, April.
    15. Valentin Zelenyuk & Zhichao Wang, 2023. "Random vs. Explained Inefficiency in Stochastic Frontier Analysis: The Case of Queensland Hospitals," CEPA Working Papers Series WP052023, School of Economics, University of Queensland, Australia.
    16. Yauheniya Varabyova & Carl Rudolf Blankart & Aleksandra Torbica & Jonas Schreyögg, 2017. "Comparing the Efficiency of Hospitals in Italy and Germany: Nonparametric Conditional Approach Based on Partial Frontier," Health Care Management Science, Springer, vol. 20(3), pages 379-394, September.
    17. Subal C. Kumbhakar & Christopher F. Parmeter & Valentin Zelenyuk, 2022. "Stochastic Frontier Analysis: Foundations and Advances I," Springer Books, in: Subhash C. Ray & Robert G. Chambers & Subal C. Kumbhakar (ed.), Handbook of Production Economics, chapter 8, pages 331-370, Springer.
    18. Berta, Paolo & Guerriero, Carla & Levaggi, Rosella, 2021. "Hospitals’ strategic behaviours and patient mobility: Evidence from Italy," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    19. Rahab Mbau & Anita Musiega & Lizah Nyawira & Benjamin Tsofa & Andrew Mulwa & Sassy Molyneux & Isabel Maina & Julie Jemutai & Charles Normand & Kara Hanson & Edwine Barasa, 2023. "Analysing the Efficiency of Health Systems: A Systematic Review of the Literature," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 205-224, March.
    20. Keller, Michael, 2020. "Wasted windfalls: Inefficiencies in health care spending in oil rich countries," Resources Policy, Elsevier, vol. 66(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:soceps:v:84:y:2022:i:c:s0038012122001835. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/seps .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.