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Understanding Inappropriateness in Health Care: The Role of Supply Structure, Pricing Policies and Political Institutions in Caesarean Deliveries

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  • Maura Francese
  • Massimiliano Piacenza

    ()

  • Marzia Romanelli
  • Gilberto Turati

Abstract

The 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 delivery, which has also been found to be strongly correlated with expenditure differentials between regions. We exploit the significant regional variation in the share of caesarean deliveries in Italy to explore the impact on inappropriateness of three groups of policy variables: 1) political economy indicators (as a way to capture different approaches to the governance of the health care sector); 2) reimbursement and pricing policies (as DRG fees); 3) structural supply indicators (such as the incidence of private providers and the number of employees). The analysis controls for the demographic characteristics of patients and their education levels. Results suggest that tariffs might be an effective policy tool to control inappropriateness; however, the structure of the regional health care system matters. More importantly, also some characteristics of the regional governments and the financing mechanisms play a role.

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Paper provided by European Regional Science Association in its series ERSA conference papers with number ersa11p1439.

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Date of creation: Sep 2011
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Handle: RePEc:wiw:wiwrsa:ersa11p1439

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  1. D. Fabbri & C. Monfardini, 2006. "Style of practice and assortative mating: a recursive probit analysis of cesarean section scheduling in Italy," Working Papers, Dipartimento Scienze Economiche, Universita' di Bologna 557, Dipartimento Scienze Economiche, Universita' di Bologna.
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  3. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, Elsevier, vol. 18(4), pages 473-490, August.
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  6. Grant, Darren, 2009. "Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project," Journal of Health Economics, Elsevier, Elsevier, vol. 28(1), pages 244-250, January.
  7. Maura Francese & Marzia Romanelli, 2011. "Healthcare in Italy: expenditure determinants and regional differentials," Temi di discussione (Economic working papers), Bank of Italy, Economic Research and International Relations Area 828, Bank of Italy, Economic Research and International Relations Area.
  8. Dubay, Lisa & Kaestner, Robert & Waidmann, Timothy, 1999. "The impact of malpractice fears on cesarean section rates," Journal of Health Economics, Elsevier, Elsevier, vol. 18(4), pages 491-522, August.
  9. 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, Wiley Blackwell, vol. 49(5), pages 931-951.
  10. 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).
  11. Massimiliano Piacenza & Gilberto Turati, 2010. "Does Fiscal Discipline towards Sub-national Governments Affect Citizens’ Well-being? Evidence on Health," Working papers, Former Department of Economics and Public Finance "G. Prato", University of Torino 12, Former Department of Economics and Public Finance "G. Prato", University of Torino.
  12. Lars-Erik Borge & Jørn Rattsø, 2003. "Property taxation as incentive for cost control: Empirical evidence for utility services in Norway," ERSA conference papers, European Regional Science Association ersa03p219, European Regional Science Association.
  13. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, Elsevier, vol. 10(4), pages 385-410.
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Cited by:
  1. 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, Springer, vol. 15(2), pages 117-132, March.

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