Understanding Inappropriateness in Health Care. The Role of Supply Structure, Pricing Policies and Political Institutions in Caesarean Deliveries
AbstractThe upward trend in the incidence of caesarean deliveries is a widespread stylised fact in many countries. Several studies have argued that it does not reflect, at least in part, patients’ needs but that it is also influenced by other factors, such as providers/physicians incentives. Not surprisingly, the incidence of caesarean sections is often used as an indicator of the degree of (in)appropriateness in health care, which has also been found to be strongly correlated with excessive expenditure levels. In this paper, we exploit the significant regional variation in the share of caesarean sections recorded in Italy to explore the impact on inappropriateness of three groups of variables: 1) structural supply indicators (e.g., the incidence of private providers); 2) pricing policies (role of DRG tariffs); 3) political economy indicators (to capture different approaches to the governance of the health care sector). The analysis controls for demand side factors, such as the demographic structure of the population and education levels. The results suggest that DRG tariffs might be an effective policy tool to control inappropriateness, once the composition of the regional health care system – in terms of private vs. public providers – is taken into account. Also some characteristics of regional governments and the funding sources of regional health spending do matter.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by Department of Economics and Statistics (Dipartimento di Scienze Economico-Sociali e Matematico-Statistiche), University of Torino in its series Working papers with number 001.
Length: 25 pages
Date of creation: Feb 2012
Date of revision:
health care; inappropriateness; regional disparities; pricing policy; political economy;
Other versions of this item:
- Maura Francese & Massimiliano Piacenza & Marzia Romanelli & Gilberto Turati, 2011. "Understanding Inappropriateness in Health Care: The Role of Supply Structure, Pricing Policies and Political Institutions in Caesarean Deliveries," ERSA conference papers ersa11p1439, European Regional Science Association.
- D78 - Microeconomics - - Analysis of Collective Decision-Making - - - Positive Analysis of Policy Formulation and Implementation
- 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
- L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out
This paper has been announced in the following NEP Reports:
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Arulampalam, Wiji & Dasgupta, Sugato & Dhillon, Amrita & Dutta, Bhaskar, 2009.
"Electoral goals and center-state transfers: A theoretical model and empirical evidence from India,"
Journal of Development Economics,
Elsevier, vol. 88(1), pages 103-119, January.
- Arulampalam, Wiji & Dasgupta, Sugato & Dhillon, Amrita & Dutta, Bhaskar, 2008. "Electoral Goals and Center-State Transfers: A Theoretical Model and Empirical Evidence from India," IZA Discussion Papers 3376, Institute for the Study of Labor (IZA).
- Wiji Arulampalam & Sugato Dasgupta & Amrita Dhillon & Bhaskar Dutta, 2008. "Electoral goals and center-state transfers: A Theoretical model and empirical evidence from India," Indian Statistical Institute, Planning Unit, New Delhi Discussion Papers 08-14, Indian Statistical Institute, New Delhi, India.
- Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, vol. 18(4), pages 491-522, August.
- Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
- McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
- Daniele Fabbri & Chiara Monfardini, 2006.
"Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy,"
CHILD Working Papers
wp06_06, CHILD - Centre for Household, Income, Labour and Demographic economics - ITALY.
- Daniele Fabbri & Chiara Monfardini, 2008. "Style of practice and assortative mating: a recursive probit analysis of Caesarean section scheduling in Italy," Applied Economics, Taylor & Francis Journals, vol. 40(11), pages 1411-1423.
- D. Fabbri & C. Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," Working Papers 557, Dipartimento Scienze Economiche, Universita' di Bologna.
- Jon H. Fiva, 2006. "New Evidence on the Effect of Fiscal Decentralization on the Size and Composition of Government Spending," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 62(2), pages 250-280, June.
- Salmon, Pierre, 1987.
"Decentralisation as an Incentive Scheme,"
Oxford Review of Economic Policy,
Oxford University Press, vol. 3(2), pages 24-43, Summer.
- SALMON, Pierre, 1987. "Decentralization as an incentive scheme," Institut des MathÃ©matiques Economiques â Document de travail de lâI.M.E. (1974-1993) 98, Institut des Mathématiques Economiques. LATEC, Laboratoire d'Analyse et des Techniques EConomiques, CNRS, Université de Bourgogne.
- Grant, Darren, 2009.
"Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project,"
Journal of Health Economics,
Elsevier, vol. 28(1), pages 244-250, January.
- Darren Grant, 2008. "Physician Financial Incentives and Cesarean Delivery: New Conclusions from the Healthcare Cost and Utilization Project," Working Papers 0801, Sam Houston State University, Department of Economics and International Business.
- Borge, Lars-Erik & Rattsø, Jørn, 2008.
"Property taxation as incentive for cost control: Empirical evidence for utility services in Norway,"
European Economic Review,
Elsevier, vol. 52(6), pages 1035-1054, August.
- Lars-Erik Borge & Jørn Rattsø, 2003. "Property taxation as incentive for cost control: Empirical evidence for utility services in Norway," ERSA conference papers ersa03p219, European Regional Science Association.
- Lars-Erik Borge & Jørn Rattsø, 2006. "Property taxation as incentive for cost control:Empirical evidence for utility services in Norway," Working Paper Series 7606, Department of Economics, Norwegian University of Science and Technology.
- Maura Francese & Marzia Romanelli, 2011. "Healthcare in Italy: expenditure determinants and regional differentials," Temi di discussione (Economic working papers) 828, Bank of Italy, Economic Research and International Relations Area.
- Ernesto Dal Bó & Martín Rossi, 2008. "Term Length and Political Performance," NBER Working Papers 14511, National Bureau of Economic Research, Inc.
- Massimiliano Piacenza & Gilberto Turati, 2010.
"Does fiscal discipline towards sub-national governments affect citizens’ well-being? evidence on health,"
2010/56, Institut d'Economia de Barcelona (IEB).
- Massimiliano Piacenza & Gilberto Turati, 2010. "Does Fiscal Discipline towards Sub-national Governments Affect Citizens’ Well-being? Evidence on Health," Working papers 12, Former Department of Economics and Public Finance "G. Prato", University of Torino.
- Baltagi, Badi H. & Wu, Ping X., 1999. "Unequally Spaced Panel Data Regressions With Ar(1) Disturbances," Econometric Theory, Cambridge University Press, vol. 15(06), pages 814-823, December.
- J. Paul Elhorst & Sandy Fréret, 2009. "Evidence Of Political Yardstick Competition In France Using A Two-Regime Spatial Durbin Model With Fixed Effects," Journal of Regional Science, Wiley Blackwell, vol. 49(5), pages 931-951.
- 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, vol. 15(2), pages 117-132, March.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Simone Pellegrino).
If references are entirely missing, you can add them using this form.