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Death by austerity? The impact of cost containment on avoidable mortality in Italy

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  • Emanuele Arcà
  • Francesco Principe
  • Eddy Van Doorslaer

Abstract

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south‐to‐north patient migration. These findings suggest that—even in a high‐income country with relatively low avoidable mortality like Italy—spending cuts can hurt survival.

Suggested Citation

  • Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.
    • Handle: RePEc:wly:hlthec:v:29:y:2020:i:12:p:1500-1516
    DOI: 10.1002/hec.4147
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    1. Chris Sampson’s journal round-up for 7th December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-07 12:00:03

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    3. Fontana, Stefania & Guccio, Calogero & Pignataro, Giacomo & Romeo, Domenica, 2026. "Cash transfers and health outcomes: Evidence from Italian municipalities," Health Policy, Elsevier, vol. 163(C).
    4. Guccio, Calogero & Pignataro, Giacomo & Romeo, Domenica & Vidoli, Francesco, 2024. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 92(C).
    5. Cristian Barra & Raffaele Lagravinese & Roberto Zotti, 2022. "Exploring hospital efficiency within and between Italian regions: new empirical evidence," Journal of Productivity Analysis, Springer, vol. 57(3), pages 269-284, June.
    6. Cirulli, Vanessa & Marini, Giorgia, 2023. "Are austerity measures really distressing? Evidence from Italy," Economics & Human Biology, Elsevier, vol. 49(C).
    7. Guccio, C. & Pignataro, G. & Vidoli, F., 2024. "It never rains but it pours: Austerity and mortality rate in peripheral areas," Economics & Human Biology, Elsevier, vol. 54(C).
    8. Boffardi, Raffaele, 2022. "How efficient is the Italian health system? Evidence on the role of political-institutional dynamics," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    9. Val Morrison & Mikołaj Zarzycki & Noa Vilchinsky & Robbert Sanderman & Giovanni Lamura & Oliver Fisher & Giulia Ferraris & Saif Elayan & Erik Buskens & Eva Bei & Anne Looijmans & Viola Angelini & Mari, 2022. "A Multinational Longitudinal Study Incorporating Intensive Methods to Examine Caregiver Experiences in the Context of Chronic Health Conditions: Protocol of the ENTWINE-iCohort," IJERPH, MDPI, vol. 19(2), pages 1-17, January.
    10. Balia, S.; & Brau, R.; & Pau, S.;, 2025. "One plus one makes less than two? Consolidation policies and mortality in the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 25/02, HEDG, c/o Department of Economics, University of York.
    11. Cavazza, Marianna & Vecchio, Mario Del & Fattore, Giovanni & Fenech, Lorenzo, 2023. "Geographical variation in the use of private health insurance in a predominantly publicly-funded system," Health Policy, Elsevier, vol. 130(C).
    12. Andrea Ciaccio, 2023. "The Impact of a Cost-containment Measure on the Quality of Regional Health Services in Italy: a Parametric and a Non-parametric Approach," Working Papers 2023: 24, Department of Economics, University of Venice "Ca' Foscari".
    13. S. Balia & R. Brau & S. Pau, 2025. "One plus one makes less than two? Consolidation policies and mortality in the Italian NHS," Working Paper CRENoS 202502, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    14. Ghislandi, Simone & Renner, Anna-Theresa & Varghese, Nirosha Elsem, 2025. "The impact of budget cuts on individual patient health: Causal evidence from hospital closures," Journal of Health Economics, Elsevier, vol. 101(C).

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