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Health Expenditure and All-Cause Mortality in the ‘Galaxy’ of Italian Regional Healthcare Systems: A 15-Year Panel Data Analysis

Author

Listed:
  • Davide Golinelli

    (University of Siena
    Alma Mater Studiorum-University of Bologna)

  • Fabrizio Toscano

    (University of Siena)

  • Andrea Bucci

    (Marche Polytechnic University)

  • Jacopo Lenzi

    (Alma Mater Studiorum-University of Bologna)

  • Maria Pia Fantini

    (Alma Mater Studiorum-University of Bologna)

  • Nicola Nante

    (University of Siena)

  • Gabriele Messina

    (University of Siena)

Abstract

Background The sustainability of healthcare systems is a topic of major interest. During periods of economic instability, policy makers typically reallocate resources and execute linear cuts in different areas of public spending, including healthcare. Objectives The aim of this paper was to examine whether and how per capita public healthcare expenditure (PHE) in the Italian regions was related to the all-cause mortality rate (MR) between 1999 and 2013 and to determine which expenditure item most affected mortality in the short and very short term. Methods We conducted a pooled cross-sectional time series study. Secondary data were extracted from ‘Health for All’, a database released periodically by the Italian National Institute of Statistics. PHE is subdivided into directly provided services (DPS), pharmaceutical care, general practitioner care, specialist medical care, privately delivered hospital care, other privately delivered medical services, and psychiatric support and rehabilitation. We used a fixed-effects regression to assess the effects of PHE items on the MR after controlling for a number of socioeconomic and supply variables. Results Higher spending on DPS was associated with a lower MR. Other expenditure variables were not significantly associated with the MR. Conclusions The results highlight the importance of medical services and goods provided directly by public services (i.e. hospital-based general and specialized wards and offices, emergency departments, etc.). DPS represents the driving force of the system and should be considered a determinant of the health of the Italian population. Our results suggest that the context and financing methods of a healthcare system should be carefully analysed before linear cuts are made or resources are reallocated.

Suggested Citation

  • Davide Golinelli & Fabrizio Toscano & Andrea Bucci & Jacopo Lenzi & Maria Pia Fantini & Nicola Nante & Gabriele Messina, 2017. "Health Expenditure and All-Cause Mortality in the ‘Galaxy’ of Italian Regional Healthcare Systems: A 15-Year Panel Data Analysis," Applied Health Economics and Health Policy, Springer, vol. 15(6), pages 773-783, December.
    • Handle: RePEc:spr:aphecp:v:15:y:2017:i:6:d:10.1007_s40258-017-0342-x
    DOI: 10.1007/s40258-017-0342-x
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    2. Yonsu Kim & Jae Hong Kim, 2022. "What drives variations in public health and social services expenditures? the association between political fragmentation and local expenditure patterns," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 781-789, July.
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    5. Guccio, C. & Pignatora, G. & Vidoli, F., 2023. "It never rains but it pours: Austerity and mortality rate in peripheral areas," Health, Econometrics and Data Group (HEDG) Working Papers 23/02, HEDG, c/o Department of Economics, University of York.
    6. Mohammad Reza Farzanegan, 2021. "The Effect of Public Corruption on Covid-19 Fatality Rate: A Cross-Country Examination," CESifo Working Paper Series 8938, CESifo.
    7. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    8. Cirulli, Vanessa & Marini, Giorgia, 2023. "Are austerity measures really distressing? Evidence from Italy," Economics & Human Biology, Elsevier, vol. 49(C).
    9. Ana Rosa Rubio-Salvador & Vicente Escudero-Vilaplana & José Antonio Marcos Rodríguez & Irene Mangues-Bafalluy & Beatriz Bernardez & Carlos García Collado & Roberto Collado-Borrell & María Dolores Alva, 2021. "Cost of Venous Thromboembolic Disease in Patients with Lung Cancer: COSTECAT Study," IJERPH, MDPI, vol. 18(2), pages 1-9, January.
    10. Sanmarchi Francesco & Esposito Francesco & Golinelli Davide & Bucci Andrea & Toscano Fabrizio, 2021. "Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries," Forum for Health Economics & Policy, De Gruyter, vol. 24(2), pages 101-118, December.
    11. 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.

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