IDEAS home Printed from
   My bibliography  Save this paper

Cost-Containment Policies in Healthcare Sector: the example of ESTAV in Tuscany


  • Andrea RIGANTI



This paper investigates the impact of the establishment of local authorities that act as purchase managers in Tuscany from 2005, replacing the former Local Health Authorities. These new authorities are responsible for the provision of goods and for the management of services; they are aimed at saving money and enhancing a more efficient allocation of resources. In order to assess the impact in terms of cost containment we use the Synthetic Control Procedure to create from the donor pool of all Italian Regions and Local Health Authorities a weighted average that could resemble the exposed units in terms of expenditures before 2005, when ESTAVs were settled. We project the path of expenditures of these “Synthetic” units in the post-intervention period with optimally assigned weights and we measure differences with respect to the real path of the cost variables. We also compute permutations to conduct valid inference: results are appearing for most of the outcome variables, are robust at classical significance levels and are homogeneous across different Local Health Authorities. Purchases of pharmaceuticals account for high share of total expenses and are the ones that deserve more attention in policy discussion.

Suggested Citation

  • Andrea RIGANTI, 2017. "Cost-Containment Policies in Healthcare Sector: the example of ESTAV in Tuscany," Departmental Working Papers 2017-12, Department of Economics, Management and Quantitative Methods at Università degli Studi di Milano.
  • Handle: RePEc:mil:wpdepa:2017-12

    Download full text from publisher

    File URL:
    Download Restriction: no

    References listed on IDEAS

    1. Marco Grazzi & Nadia Jacoby & Tania Treibich, 2015. "Persistance du comportement d’investissement dans le secteur manufacturier français ," Revue d'économie industrielle, De Boeck Université, vol. 0(2), pages 51-79.
    2. Micheline Goedhuys & Leo Sleuwaegen, 2010. "High-growth entrepreneurial firms in Africa: a quantile regression approach," Small Business Economics, Springer, vol. 34(1), pages 31-51, January.
    3. Mike Wright & Bart Clarysse & Philippe Mustar & Andy Lockett, 2007. "Academic Entrepreneurship in Europe," Books, Edward Elgar Publishing, number 4041.
    4. Etzkowitz, Henry & Leydesdorff, Loet, 2000. "The dynamics of innovation: from National Systems and "Mode 2" to a Triple Helix of university-industry-government relations," Research Policy, Elsevier, vol. 29(2), pages 109-123, February.
    5. Friedman, Joseph & Silberman, Jonathan, 2003. "University Technology Transfer: Do Incentives, Management, and Location Matter?," The Journal of Technology Transfer, Springer, vol. 28(1), pages 17-30, January.
    6. Saul Lach & Mark Schankerman, 2008. "Incentives and invention in universities," RAND Journal of Economics, RAND Corporation, vol. 39(2), pages 403-433.
    7. Gilsing, V.A. & van Burg, E. & Romme, A.G.L., 2010. "Policy principles for the creation and success of corporate and academic spin-offs," Other publications TiSEM 4f828c53-0ac2-4ea7-9f90-4, Tilburg University, School of Economics and Management.
    8. Marco Grazzi & Nadia Jacoby & Tania Treibich, 2015. "Persistance du comportement d’investissement dans le secteur manufacturier français ‪," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-01241676, HAL.
    9. Siegel, Donald S. & Waldman, David & Link, Albert, 2003. "Assessing the impact of organizational practices on the relative productivity of university technology transfer offices: an exploratory study," Research Policy, Elsevier, vol. 32(1), pages 27-48, January.
    10. Dirk Czarnitzki & Christian Rammer & Andrew Toole, 2014. "University spin-offs and the “performance premium”," Small Business Economics, Springer, vol. 43(2), pages 309-326, August.
    11. Kenney, Martin & Richard Goe, W., 2004. "The role of social embeddedness in professorial entrepreneurship: a comparison of electrical engineering and computer science at UC Berkeley and Stanford," Research Policy, Elsevier, vol. 33(5), pages 691-707, July.
    12. Moshe Buchinsky, 1998. "Recent Advances in Quantile Regression Models: A Practical Guideline for Empirical Research," Journal of Human Resources, University of Wisconsin Press, vol. 33(1), pages 88-126.
    13. Shaker A. Zahra & Els Van de Velde & Bárbara Larrañeta, 2007. "Knowledge conversion capability and the performance of corporate and university spin-offs," Industrial and Corporate Change, Oxford University Press, vol. 16(4), pages 569-608, August.
    14. Parente Paulo M.D.C. & Santos Silva João M.C., 2016. "Quantile Regression with Clustered Data," Journal of Econometric Methods, De Gruyter, vol. 5(1), pages 1-15, January.
    15. Marianne Bertrand & Antoinette Schoar, 2003. "Managing with Style: The Effect of Managers on Firm Policies," The Quarterly Journal of Economics, Oxford University Press, vol. 118(4), pages 1169-1208.
    16. Nicholas Bloom & Erik Brynjolfsson & Lucia Foster & Ron Jarmin & Megha Patnaik & Itay Saporta-Eksten & John Van Reenen, 2017. "What Drives Differences in Management?," CEP Discussion Papers dp1470, Centre for Economic Performance, LSE.
    17. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," Review of Economic Studies, Oxford University Press, vol. 82(2), pages 457-489.
    18. Huergo, Elena & Jaumandreu, Jordi, 2004. "Firms' age, process innovation and productivity growth," International Journal of Industrial Organization, Elsevier, vol. 22(4), pages 541-559, April.
    19. Nicholas Bloom & Renata Lemos & Raffaella Sadun & Daniela Scur & John Reenen, 2014. "Jeea-Fbbva Lecture 2013: The New Empirical Economics Of Management," Journal of the European Economic Association, European Economic Association, vol. 12(4), pages 835-876, August.
    20. Macho-Stadler, Ines & Perez-Castrillo, David & Veugelers, Reinhilde, 2007. "Licensing of university inventions: The role of a technology transfer office," International Journal of Industrial Organization, Elsevier, vol. 25(3), pages 483-510, June.
    21. David Audretsch & Marcel Hülsbeck & Erik Lehmann, 2012. "Regional competitiveness, university spillovers, and entrepreneurial activity," Small Business Economics, Springer, vol. 39(3), pages 587-601, October.
    22. Clarysse, Bart & Wright, Mike & Lockett, Andy & Van de Velde, Els & Vohora, Ajay, 2005. "Spinning out new ventures: a typology of incubation strategies from European research institutions," Journal of Business Venturing, Elsevier, vol. 20(2), pages 183-216, March.
    23. Nerkar, Atul & Shane, Scott, 2003. "When do start-ups that exploit patented academic knowledge survive?," International Journal of Industrial Organization, Elsevier, vol. 21(9), pages 1391-1410, November.
    24. Fini, Riccardo & Grimaldi, Rosa & Santoni, Simone & Sobrero, Maurizio, 2011. "Complements or substitutes? The role of universities and local context in supporting the creation of academic spin-offs," Research Policy, Elsevier, vol. 40(8), pages 1113-1127, October.
    25. Giulio Bottazzi & Angelo Secchi, 2003. "Common Properties and Sectoral Specificities in the Dynamics of U.S. Manufacturing Companies," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 23(3_4), pages 217-232, December.
    26. Nicolaou, Nicos & Birley, Sue, 2003. "Academic networks in a trichotomous categorisation of university spinouts," Journal of Business Venturing, Elsevier, vol. 18(3), pages 333-359, May.
    27. Frank T. Rothaermel & Shanti D. Agung & Lin Jiang, 2007. "University entrepreneurship: a taxonomy of the literature," Industrial and Corporate Change, Oxford University Press, vol. 16(4), pages 691-791, August.
    28. Erika Färnstrand Damsgaard & Marie C. Thursby, 2013. "University entrepreneurship and professor privilege," Industrial and Corporate Change, Oxford University Press, vol. 22(1), pages 183-218, February.
    29. Åstebro, Thomas & Bazzazian, Navid & Braguinsky, Serguey, 2012. "Startups by recent university graduates and their faculty: Implications for university entrepreneurship policy," Research Policy, Elsevier, vol. 41(4), pages 663-677.
    30. Nicholas Bloom & John Van Reenen, 2010. "Why Do Management Practices Differ across Firms and Countries?," Journal of Economic Perspectives, American Economic Association, vol. 24(1), pages 203-224, Winter.
    31. Bozeman, Barry & Rimes, Heather & Youtie, Jan, 2015. "The evolving state-of-the-art in technology transfer research: Revisiting the contingent effectiveness model," Research Policy, Elsevier, vol. 44(1), pages 34-49.
    32. Djordje Djokovic & Vangelis Souitaris, 2008. "Spinouts from academic institutions: a literature review with suggestions for further research," The Journal of Technology Transfer, Springer, vol. 33(3), pages 225-247, June.
    33. Gideon D. Markman & Peter T. Gianiodis & Phillip H. Phan & David B. Balkin, 2004. "Entrepreneurship from the Ivory Tower: Do Incentive Systems Matter?," The Journal of Technology Transfer, Springer, vol. 29(3_4), pages 353-364, August.
    34. Delmar, Frederic & Davidsson, Per & Gartner, William B., 2003. "Arriving at the high-growth firm," Journal of Business Venturing, Elsevier, vol. 18(2), pages 189-216, March.
    35. repec:hal:journl:halshs-01241676 is not listed on IDEAS
    36. March, James G., 1988. "Variable risk preferences and adaptive aspirations," Journal of Economic Behavior & Organization, Elsevier, vol. 9(1), pages 5-24, January.
    37. Nicholas Bloom & Christos Genakos & Raffaella Sadun & John Van Reenen, 2011. "Management Practices Across Firms and Countries," CEP Discussion Papers dp1109, Centre for Economic Performance, LSE.
    38. Coad, Alex & Rao, Rekha, 2008. "Innovation and firm growth in high-tech sectors: A quantile regression approach," Research Policy, Elsevier, vol. 37(4), pages 633-648, May.
    39. Alessandro Muscio & Davide Quaglione & Giovanna Vallanti, 2015. "University regulation and university–industry interaction: a performance analysis of Italian academic departments," Industrial and Corporate Change, Oxford University Press, vol. 24(5), pages 1047-1079.
    40. Di Gregorio, Dante & Shane, Scott, 2003. "Why do some universities generate more start-ups than others?," Research Policy, Elsevier, vol. 32(2), pages 209-227, February.
    41. Perkmann, Markus & Tartari, Valentina & McKelvey, Maureen & Autio, Erkko & Broström, Anders & D’Este, Pablo & Fini, Riccardo & Geuna, Aldo & Grimaldi, Rosa & Hughes, Alan & Krabel, Stefan & Kitson, Mi, 2013. "Academic engagement and commercialisation: A review of the literature on university–industry relations," Research Policy, Elsevier, vol. 42(2), pages 423-442.
    42. Muscio, Alessandro & Quaglione, Davide & Ramaciotti, Laura, 2016. "The effects of university rules on spinoff creation: The case of academia in Italy," Research Policy, Elsevier, vol. 45(7), pages 1386-1396.
    43. Crawford, G. Christopher & Aguinis, Herman & Lichtenstein, Benyamin & Davidsson, Per & McKelvey, Bill, 2015. "Power law distributions in entrepreneurship: Implications for theory and research," Journal of Business Venturing, Elsevier, vol. 30(5), pages 696-713.
    44. David Audretsch, 2014. "From the entrepreneurial university to the university for the entrepreneurial society," The Journal of Technology Transfer, Springer, vol. 39(3), pages 313-321, June.
    45. Janet Bercovitz & Maryann Feldman, 2008. "Academic Entrepreneurs: Organizational Change at the Individual Level," Organization Science, INFORMS, vol. 19(1), pages 69-89, February.
    46. Josh Lerner, 2005. "The University and the Start-Up:Lessons from the Past Two Decades," The Journal of Technology Transfer, Springer, vol. 30(2_2), pages 49-56, January.
    47. O'Shea, Rory P. & Allen, Thomas J. & Chevalier, Arnaud & Roche, Frank, 2005. "Entrepreneurial orientation, technology transfer and spinoff performance of U.S. universities," Research Policy, Elsevier, vol. 34(7), pages 994-1009, September.
    48. John McCormack & Carol Propper & Sarah Smith, 2014. "Herding Cats? Management and University Performance," Economic Journal, Royal Economic Society, vol. 124(578), pages 534-564, August.
    49. Tina C. Ambos & Kristiina Mäkelä & Julian Birkinshaw & Pablo D'Este, 2008. "When Does University Research Get Commercialized? Creating Ambidexterity in Research Institutions," Journal of Management Studies, Wiley Blackwell, vol. 45(8), pages 1424-1447, December.
    50. Coad, Alex & Frankish, Julian & Roberts, Richard G. & Storey, David J., 2013. "Growth paths and survival chances: An application of Gambler's Ruin theory," Journal of Business Venturing, Elsevier, vol. 28(5), pages 615-632.
    51. Vincett, P.S., 2010. "The economic impacts of academic spin-off companies, and their implications for public policy," Research Policy, Elsevier, vol. 39(6), pages 736-747, July.
    52. Landry, Rejean & Amara, Nabil & Rherrad, Imad, 2006. "Why are some university researchers more likely to create spin-offs than others? Evidence from Canadian universities," Research Policy, Elsevier, vol. 35(10), pages 1599-1615, December.
    53. Grimaldi, Rosa & Kenney, Martin & Siegel, Donald S. & Wright, Mike, 2011. "30 years after Bayh-Dole: Reassessing academic entrepreneurship," Research Policy, Elsevier, vol. 40(8), pages 1045-1057, October.
    54. Grandi, Alessandro & Grimaldi, Rosa, 2003. "Exploring the Networking Characteristics of New Venture Founding Teams," Small Business Economics, Springer, vol. 21(4), pages 329-341, December.
    55. Kesidou, Effie & Demirel, Pelin, 2012. "On the drivers of eco-innovations: Empirical evidence from the UK," Research Policy, Elsevier, vol. 41(5), pages 862-870.
    56. Donald S. Siegel & Mike Wright & Andy Lockett, 2007. "The rise of entrepreneurial activity at universities: organizational and societal implications," Industrial and Corporate Change, Oxford University Press, vol. 16(4), pages 489-504, August.
    Full references (including those not matched with items on IDEAS)

    More about this item


    Cost containment; Healthcare sector; Synthetic Control;

    JEL classification:

    • H41 - Public Economics - - Publicly Provided Goods - - - Public Goods
    • I10 - Health, Education, and Welfare - - Health - - - General


    Access and download statistics


    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:mil:wpdepa:2017-12. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (DEMM Working Papers). General contact details of provider: .

    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.

    We have no references for this item. You can help adding them by using 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.