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The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation

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  • Berta, Paolo
  • Callea, Giuditta
  • Martini, Gianmaria
  • Vittadini, Giorgio

Abstract

In this paper we analyze the effects of some distortions induced by the prospective payment system, i.e. upcoding, cream skimming and readmissions, on hospitals' technical efficiency. We estimate a production function using a population-based dataset composed by all active hospitals in an Italian region during the period 1998-2007. We show that cream skimming and upcoding have a negative impact on hospitals' technical efficiency, while readmissions have a positive effect. Moreover, the results indicate that private hospitals engage more in cream skimming than public and not-for-profit ones, while we observe no ownership differences regarding upcoding. Not-for-profit hospitals have the highest readmission index. Last, not-for-profit and public hospitals have the same efficiency levels, while private hospitals have the lowest technical efficiency.

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  • 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.
  • Handle: RePEc:eee:ecmode:v:27:y:2010:i:4:p:812-821
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    Cited by:

    1. Roberto Colombi & Subal Kumbhakar & Gianmaria Martini & Giorgio Vittadini, 2014. "Closed-skew normality in stochastic frontiers with individual effects and long/short-run efficiency," Journal of Productivity Analysis, Springer, vol. 42(2), pages 123-136, October.
    2. Rosella Levaggi & Marcello Montefiori, 2013. "Patient selection in a mixed oligopoly market for health care: the role of the soft budget constraint," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 60(1), pages 49-70, March.
    3. Moscone, Francesco & Tosetti, Elisa & Vittadini, Giorgio, 2009. "Social Interaction in Patients'�Hospital Choice: Evidences from Italy," MPRA Paper 17783, University Library of Munich, Germany.
    4. Thomas Czypionka & Markus Kraus & Susanne Mayer & Gerald Röhrling, 2014. "Efficiency, ownership, and financing of hospitals: The case of Austria," Health Care Management Science, Springer, vol. 17(4), pages 331-347, December.
    5. Giorgio Vittadini & Paolo Berta & Gianmaria Martini & Giuditta Callea, 2012. "The effect of a law limiting upcoding on hospital admissions: evidence from Italy," Empirical Economics, Springer, vol. 42(2), pages 563-582, April.
    6. repec:kap:hcarem:v:20:y:2017:i:3:d:10.1007_s10729-016-9359-1 is not listed on IDEAS
    7. Claudio Pinto, 2014. "Efficiency comparison for directly managed public hospitals for different geographical area in Italy," Working papers 5, Società Italiana di Economia Pubblica.
    8. Georgescu, Irène & Hartmann, Frank G.H., 2013. "Sources of financial pressure and up coding behavior in French public hospitals," Health Policy, Elsevier, vol. 110(2), pages 156-163.
    9. repec:ctc:serie1:def9 is not listed on IDEAS
    10. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    11. Guccio, Calogero & Lisi, Domenico & Pignataro, Giacomo, 2014. "Readmission and Hospital Quality under Prospective Payment System," MPRA Paper 56490, University Library of Munich, Germany.
    12. Hailu, Kidanemariam Berhe & Tanaka, Makoto, 2015. "A “true” random effects stochastic frontier analysis for technical efficiency and heterogeneity: Evidence from manufacturing firms in Ethiopia," Economic Modelling, Elsevier, vol. 50(C), pages 179-192.
    13. Elenka Brenna & Federico Spandonaro, 2014. "Does federalism induce patients’ mobility across regions? Evidence from the Italian experience," DISCE - Working Papers del Dipartimento di Economia e Finanza def009, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    14. Bettina Campedelli & Andrea Guerrina & Giulia Romano & Chiara Leardini, 2014. "La performance della rete ospedaliera pubblica della regione Veneto. L’impatto delle variabili ambientali e operative sull’efficienza," MECOSAN. Menagement e economia sanitaria, FrancoAngeli Editore, vol. 2014(92), pages 119-142.
    15. repec:kap:ijhcfe:v:17:y:2017:i:1:d:10.1007_s10754-016-9201-9 is not listed on IDEAS
    16. Roberto Colombi & Gianmaria Martini & Giorgio Vittadini, 2011. "A Stochastic Frontier Model with short-run and long-run inefficiency random effects," Working Papers 1101, Department of Economics and Technology Management, University of Bergamo.
    17. repec:eee:hepoli:v:121:y:2017:i:11:p:1186-1193 is not listed on IDEAS
    18. Paolo Berta & Chiara Seghieri & Giorgio Vittadini, 2013. "Comparing health outcomes among hospitals: the experience of the Lombardy Region," Health Care Management Science, Springer, vol. 16(3), pages 245-257, September.
    19. Helmut Herwartz & Christoph Strumann, 2014. "Hospital efficiency under prospective reimbursement schemes: an empirical assessment for the case of Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(2), pages 175-186, March.
    20. Borisova, Ekaterina I. & Peresetsky, Anatoly & Polishchuk, Leonid, 2010. "Stochastic frontier in non-profit associations’ performance assessment (the case of homeowners’ associations)," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 20(4), pages 75-101.
    21. Cavalieri, M. & Guccio, C. & Lisi, D. & Pignataro, G., 2015. "Does the Extent of Per-Case Payment System Affect Hospital Efficiency? Evidence from the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 15/29, HEDG, c/o Department of Economics, University of York.
    22. Di Giorgio, L. & Filippini, M. & Masiero, G., 2015. "Structural and managerial cost differences in nonprofit nursing homes," Economic Modelling, Elsevier, vol. 51(C), pages 289-298.
    23. 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.
    24. Cheng, Terence C. & Haisken-DeNew, John P. & Yong, Jongsay, 2015. "Cream skimming and hospital transfers in a mixed public-private system," Social Science & Medicine, Elsevier, vol. 132(C), pages 156-164.

    More about this item

    Keywords

    Upcoding Cream skimming Readmission Hospital technical efficiency Ownership;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • C50 - Mathematical and Quantitative Methods - - Econometric Modeling - - - General
    • 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

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