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Behavioral Differences Between Public and Private Not-For-Profit Hospitals in the Italian National Health Service

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  • Gian Paolo Barbetta

    () (Istituto di Economia e Finanza (Univ. Cattolica MI)

  • Gilberto Turati

    () (Dipartimento di Scienze economiche e Finanziarie)

  • Angelo Zago

    () (Dipartimento di Scienze economiche)

Abstract

In this paper we attempt to identify behavioral differences between public and private not-forprofit hospitals, by using the opportunity of the introduction of the DRG-based payment system in the Italian NHS during the second half of the Nineties. We estimate the technical efficiency of a sample of hospitals for the period 1995-2000 considering an output distance function, and adopting both parametric (COLS) and non-parametric (DEA) approaches. All our results show a convergence of mean efficiency scores between not-for-profit and public hospitals, and seem to suggest that differences in economic performances between competing ownership forms are more the result of the institutional settings in which they operate than the effect of the incentive structures embedded in the different proprietary forms. Contrary to expectation we also observe a decline in technical efficiency, probably due to policies aimed at reducing hospitalization rates.

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File URL: http://dse.univr.it/RePEc/ver/Wpaper/WP12.pdf
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Bibliographic Info

Paper provided by University of Verona, Department of Economics in its series Working Papers with number 12.

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Length: 30
Date of creation: Oct 2004
Date of revision:
Publication status: Forthcoming on Health Economics
Handle: RePEc:ver:wpaper:12

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Keywords: forms; technical efficiency; nonprofit organizations; hospital behavior; payment systems.;

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References

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  6. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
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  8. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
  9. Mark G. Duggan, 2000. "Hospital Ownership And Public Medical Spending," The Quarterly Journal of Economics, MIT Press, vol. 115(4), pages 1343-1373, November.
  10. Jondrow, James & Knox Lovell, C. A. & Materov, Ivan S. & Schmidt, Peter, 1982. "On the estimation of technical inefficiency in the stochastic frontier production function model," Journal of Econometrics, Elsevier, vol. 19(2-3), pages 233-238, August.
  11. Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
  12. Zuckerman, Stephen & Hadley, Jack & Iezzoni, Lisa, 1994. "Measuring hospital efficiency with frontier cost functions," Journal of Health Economics, Elsevier, vol. 13(3), pages 255-280, October.
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  14. Gilberto Turati & Gian Paolo Barbetta, 2001. "L'analisi dell'efficienza tecnica nel settore della sanità. Un'applicazione al caso della Lombardia," ECONOMIA PUBBLICA, FrancoAngeli Editore, vol. 2001(2).
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Cited by:
  1. 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.
  2. Federico Belotti & Giuseppe Ilardi, 2012. "Consistent Estimation of the “True” Fixed-effects Stochastic Frontier Model," CEIS Research Paper 231, Tor Vergata University, CEIS, revised 18 Apr 2012.
  3. Street, Andrew & Sivey, Peter & Mason, Anne & Miraldo, Marisa & Siciliani, Luigi, 2010. "Are English treatment centres treating less complex patients?," Health Policy, Elsevier, vol. 94(2), pages 150-157, February.
  4. Berta, Paolo & Callea, Giuditta & Martini, Gianmaria & Vittadini, Giorgio, 2010. "The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation," Economic Modelling, Elsevier, vol. 27(4), pages 812-821, July.
  5. De Nicola, Arianna & Gitto, Simone & Mancuso, Paolo, 2011. "A two-stage DEA model to evaluate the efficiency of the Italian health system," MPRA Paper 39126, University Library of Munich, Germany.
  6. Silvio Daidone & Francesco D'Amico, 2009. "Technical Efficiency, Specialization and Ownership Form: Evidences from a Pooling of Italian Hospitals," CEIS Research Paper 143, Tor Vergata University, CEIS, revised 30 Sep 2009.
  7. Ng, Ying Chu, 2011. "The productive efficiency of Chinese hospitals," China Economic Review, Elsevier, vol. 22(3), pages 428-439, September.
  8. Helmut Herwartz & Christoph Strumann, 2012. "On the effect of prospective payment on local hospital competition in Germany," Health Care Management Science, Springer, vol. 15(1), pages 48-62, March.
  9. Abbas, Touqeer & Awan, Masood Sarwar & Aslam, Muhammad Amir & Waqas, Muhammad, 2011. "Analyzing the efficiency differences among basic health units in Sargodha District," MPRA Paper 32244, University Library of Munich, Germany.
  10. Lagravinese, Raffaele & Paradiso, Massimo, 2012. "Corruption and health expenditure in Italy," MPRA Paper 43215, University Library of Munich, Germany.

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