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The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies

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  • Alessandra Cepparulo

    (Sapienza-University of Rome)

  • Luisa Giuriato

    (Sapienza-University of Rome)

Abstract

In Italy, the COVID-19 pandemic and the death of many elderly people have put in evidence the uneven territorial distribution of nursing homes, which have amplified the spread and severity of the pandemic. By applying a pooled OLS model to the Italian regions, over the 2010–18 period, we investigate the demand factors, market forces and institutional drivers of the spatial distribution of residential healthcare for the elderly. Using a fine-grained approach that considers specific regional and age-related elements and the market environment, which can reduce or increase the pressure on regional governments to provide formal assistance, we find that the financial resources and the availability of unemployed women as potential caregivers explain the distribution of expenditure better than the health needs of the elderly. As a result, the expenditure is concentrated in richer and more financially autonomous regions and it is not congruent with the distribution of chronicity, health and frailty factors or income among the elderly. These critical issues of the care services for frail elderly people, related to a highly decentralized governance and resulting in fragmented, market-driven provision, could be attacked only by a national reform.

Suggested Citation

  • Alessandra Cepparulo & Luisa Giuriato, 2022. "The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(4), pages 671-685, June.
    • Handle: RePEc:spr:eujhec:v:23:y:2022:i:4:d:10.1007_s10198-021-01388-9
    DOI: 10.1007/s10198-021-01388-9
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    as
    1. Andrés Rodríguez-Pose & Roberto Ezcurra, 2010. "Does decentralization matter for regional disparities? A cross-country analysis," Journal of Economic Geography, Oxford University Press, vol. 10(5), pages 619-644, September.
    2. Anke S. Kessler & Nico A. Hansen & Christian Lessmann, 2011. "Interregional Redistribution and Mobility in Federations: A Positive Approach," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 78(4), pages 1345-1378.
    3. Joan Costa‐Font & Jordi Pons‐Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306, March.
    4. Boussofiane, A. & Dyson, R. G. & Thanassoulis, E., 1991. "Applied data envelopment analysis," European Journal of Operational Research, Elsevier, vol. 52(1), pages 1-15, May.
    5. Foremny, Dirk, 2014. "Sub-national deficits in European countries: The impact of fiscal rules and tax autonomy," European Journal of Political Economy, Elsevier, vol. 34(C), pages 86-110.
    6. Sicsic, Jonathan & Ravesteijn, Bastian & Rapp, Thomas, 2020. "Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data," Health Policy, Elsevier, vol. 124(8), pages 865-872.
    7. Guillem López-Casasnovas & Marc Saez, 2007. "A multilevel analysis on the determinants of regional health care expenditure: a note," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 59-65, March.
    8. Paolo Mancuso & Vivian Grace Valdmanis, 2016. "Care Appropriateness and Health Productivity Evolution: A Non-Parametric Analysis of the Italian Regional Health Systems," Applied Health Economics and Health Policy, Springer, vol. 14(5), pages 595-607, October.
    9. Cinzia Daraio & Léopold Simar, 2007. "Conditional nonparametric frontier models for convex and nonconvex technologies: a unifying approach," Journal of Productivity Analysis, Springer, vol. 28(1), pages 13-32, October.
    10. John Ashworth & Emma Galli & Fabio Padovano, 2013. "Decentralization as a constraint to Leviathan: a panel cointegration analysis," Public Choice, Springer, vol. 156(3), pages 491-516, September.
    11. Margherita Giannoni & Theodore Hitiris, 2002. "The regional impact of health care expenditure: the case of Italy," Applied Economics, Taylor & Francis Journals, vol. 34(14), pages 1829-1836.
    12. Joe Sarkis, 2007. "Preparing Your Data for DEA," Springer Books, in: Joe Zhu & Wade D. Cook (ed.), Modeling Data Irregularities and Structural Complexities in Data Envelopment Analysis, chapter 0, pages 305-320, Springer.
    13. Caves, Douglas W & Christensen, Laurits R & Diewert, W Erwin, 1982. "The Economic Theory of Index Numbers and the Measurement of Input, Output, and Productivity," Econometrica, Econometric Society, vol. 50(6), pages 1393-1414, November.
    14. Alberto Marino & David Morgan & Luca Lorenzoni & Chris James, 2017. "Future trends in health care expenditure: A modelling framework for cross-country forecasts," OECD Health Working Papers 95, OECD Publishing.
    15. John Thornton, 2009. "The (non)impact of revenue decentralization on fiscal deficits: some evidence from OECD countries," Applied Economics Letters, Taylor & Francis Journals, vol. 16(14), pages 1461-1466.
    16. Zhou Yang & Edward C. Norton & Sally C. Stearns, 2003. "Longevity and Health Care Expenditures," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 58(1), pages 2-10.
    17. Laura Crespo, 2006. "Caring for Parents and Employment Status of European Mid-Life Women," Working Papers wp2006_0615, CEMFI.
    18. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Economics and Management, Springer, vol. 10(3), pages 219-237, September.
    19. Di Novi, Cinzia & Piacenza, Massimiliano & Robone, Silvana & Turati, Gilberto, 2019. "Does fiscal decentralization affect regional disparities in health? Quasi-experimental evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    20. Mieke Beth Thomeer & Stipica Mudrazija & Jacqueline L. Angel, 2016. "Relationship Status and Long-Term Care Facility Use in Later Life," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 71(4), pages 711-723.
    21. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    22. Toth, Federico, 2014. "How health care regionalisation in Italy is widening the North–South gap," Health Economics, Policy and Law, Cambridge University Press, vol. 9(3), pages 231-249, July.
    23. Cavalieri, Marina & Ferrante, Livio, 2020. "Convergence, decentralization and spatial effects: An analysis of Italian regional health outcomes," Health Policy, Elsevier, vol. 124(2), pages 164-173.
    24. David Prieto & Santiago Lago-Peñas, 2012. "Decomposing the determinants of health care expenditure: the case of Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 19-27, February.
    25. Di Matteo, Livio, 2005. "The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time," Health Policy, Elsevier, vol. 71(1), pages 23-42, January.
    26. 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.
    27. Depalo, Domenico, 2019. "The side effects on health of a recovery plan in Italy: A nonparametric bounding approach," Regional Science and Urban Economics, Elsevier, vol. 78(C).
    28. Wade D. Cook & Joe Zhu, 2007. "Data Irregularities And Structural Complexities In Dea," Springer Books, in: Joe Zhu & Wade D. Cook (ed.), Modeling Data Irregularities and Structural Complexities in Data Envelopment Analysis, chapter 0, pages 1-11, Springer.
    29. Massimiliano Piacenza & Gilberto Turati, 2014. "Does Fiscal Discipline Towards Subnational Governments Affect Citizens' Well‐Being? Evidence On Health," Health Economics, John Wiley & Sons, Ltd., vol. 23(2), pages 199-224, February.
    30. John Nixon & Philippe Ulmann, 2006. "The relationship between health care expenditure and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 7-18, March.
    31. Timothy J. Coelli & D.S. Prasada Rao & Christopher J. O’Donnell & George E. Battese, 2005. "An Introduction to Efficiency and Productivity Analysis," Springer Books, Springer, edition 0, number 978-0-387-25895-9, September.
    32. Vatter, Adrian & Rüefli, Christian, 2003. "Do Political Factors Matter for Health Care Expenditure? A Comparative Study of Swiss Cantons," Journal of Public Policy, Cambridge University Press, vol. 23(3), pages 301-323, September.
    33. Bordignon, Massimo & Turati, Gilberto, 2009. "Bailing out expectations and public health expenditure," Journal of Health Economics, Elsevier, vol. 28(2), pages 305-321, March.
    34. Luiz R. De Mello Jr., 2004. "Can Fiscal Decentralization Strengthen Social Capital?," Public Finance Review, , vol. 32(1), pages 4-35, January.
    35. Eyraud, Luc & Lusinyan, Lusine, 2013. "Vertical fiscal imbalances and fiscal performance in advanced economies," Journal of Monetary Economics, Elsevier, vol. 60(5), pages 571-587.
    36. Di Matteo, Livio & Di Matteo, Rosanna, 1998. "Evidence on the determinants of Canadian provincial government health expenditures: 1965-1991," Journal of Health Economics, Elsevier, vol. 17(2), pages 211-228, April.
    37. Hansjörg Blöchliger & David Bartolini & Sibylle Stossberg, 2016. "Does Fiscal Decentralisation Foster Regional Convergence?," OECD Economic Policy Papers 17, OECD Publishing.
    38. 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.
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    More about this item

    Keywords

    Long-term care facilities; Nursing homes; Elderly care; Regional divergence; Healthcare decentralization; Informal care;
    All these keywords.

    JEL classification:

    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • R50 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - General

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